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Apply For Uniting For Ukraine

Only for Ukranian Citizens with valid passport. Please send a copy of your passport and a recent photograph with all the related documents to dalitsolidarity@gmail.com. Please feel free to fill as much as you can. You can also leave the fields empty or just write ‘Not Applicable’.

1. Beneficiary's Current Legal Name (as in the Passport) *

First

Last

2. Date of Birth (as in the Passport) (mm/dd/yyyy) *

3. Gender *

Male
Female
Other

4. Place of Birth (City/Town/State/Province/Country)

5. Country of Citizenship or Nationality

Only Ukranian Citizens can apply for this programme

6. Passport Number of the beneficiary's most recently issued passport (optional)

7. Country that issued the most recently issued passport (optional)

8. Expiration date for the most recently issued passport (mm/dd/yyyy) (optional)

9. Marital Status of the beneficiary

Single or Never Married
Married
Divorced
Widowed
Legally Separated
Marriage Annulled
Other

10. Beneficiary's Email Address (if any)

11. Beneficiary's Mobile Telephone Number (if any)

12. USA Contact Information of the beneficiary (name and phone number if any)

13. Beneficiary's Mailing Address *

Communication address in Ukraine

14. City or Town *

Communication address in Ukraine

15. State *

Communication address in Ukraine

16. ZIP Code *

17. Country *

18. Are you, or any person included in this application, now in exclusion, deportation, removal or rescission proceedings?

Yes
No

19. If "Yes" give more information

20. Have you ever before been issued a re-entry permit or Humanitarian Parol Document?

Yes
No

21. If "Yes" give more information for the last document issued to you

22. Is there anything else you would like to tell us about you that you feel we should know or understand?

23. How did you hear about us?

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