[DATE] VIA CERTIFIED MAIL AND RETURN RECEIPT United States Citizenship and Immigration Services USCIS Phoenix

Lockbox Facility P.O. Box 20700 Phoenix, AZ 85036-0700 (**This is the lockbox facility for certain applicants. Please refer to Step 6, page 2 for the address that applies to you**) REQUEST FOR DEFERRED ACTION FOR CHILDHOOD ARRIVALS RE: [CLIENTS NAME] [(DOB: MO/DA/YEAR)]

Dear USCIS Officer: Please find enclosed the I-821D Application for Consideration of Deferred Action for Childhood Arrivals of Mr./Ms. [CLIENTS FULL NAME] with supporting documentation. Also enclosed are the required I-765 Application for Employment Authorization and the I-765WS Worksheet. Summary [Mr./Ms. LAST NAME] is requesting deferred action as a childhood arrival to the United States, as defined by the USCIS Memorandum issued on June 15, 2012. USCIS Memorandum, J. Napolitano, Exercising Prosecutorial Discretion with Respect to Individuals Who Came to the United States as Children (June 15, 2012). [Mr./Ms. LAST NAMEs] meets all of the eligibility requirements for deferred action for childhood arrivals [DACA]. Specifically, [Mr./Ms. LAST NAME] is able to prove that [s/he]: 1) Entered without inspection before June 15, 2012, or [his/her] lawful immigration status expired as of June 15, 2012; 2) Is at least 15 years at the time of filing [if not in removal/ordered removed]; 3) Arrived in the United States before the age of 16; 4) Was under the age of 31 on June 15, 2012; 5) Has continuously resided in the United States since June 15, 2007, up to the present time; 6) Was present in the United States on June 15, 2012; and 7) Is currently in school, graduated or received a certificate of completion from high school, obtained a GED, or is an honorably discharged veteran of the Coast Guard or U.S. Armed Forces. The documentation submitted in support of [Mr./Ms. LAST NAMEs] application demonstrates that [his/her] eligibility pursuant to the requirements above:

1) Immigration Status a. [Case facts] b. [Reference evidence in Exhibit A] 2) Age Requirement a. [Case facts] b. [Reference evidence in Exhibit B] 3) Age at Arrival a. [Case facts] b. [Reference evidence in Exhibit C] 4) Age on June 15, 2012 a. [Case facts] b. [Reference evidence in Exhibit D] 5) Continuous Residence Since June 15, 2007 a. [Case facts] b. [Reference evidence in Exhibit E] 6) Physical Presence on June 15, 2012 a. [Case facts] b. [Reference evidence in Exhibit F] 7) Education a. [Case facts] b. [Reference evidence in Exhibit G] The enclosed documents establish [Mr./Ms. LAST NAMEs] eligibility for relief under DACA. Copies of documents submitted are exact photocopies of unaltered original documents. If required, [Mr./Ms/ LAST NAME] will submit original documents to an Immigration Official. Furthermore, [Mr./Ms/ LAST NAME] is submitting the required fees of $380 for the I-765 application and the $85 biometric services fee. If you have any questions, please do not hesitate to contact me at [Phone]. Thank you in advance for your assistance. Sincerely,

Enclosures cc: File, [CLIENT NAME]