السلام عليكم
اخوان اكو سؤال صار اسبوع مدوخني وهو مال البنافتز مال SIV
اي برنامج اختار الاولى او الثانية - الثانية اي او اوم او اني غلطان
المساعدة شباب Refugee Benefits Election Form
PLEASE INDICATE YOUR ELECTION BELOW:
If approved to receive a Special Immigrant Visa,
_____ I wish to participate in the U.S. Department of State’s resettlement program and receive
the associated benefits including IOM-arranged travel. If there are any changes in my intention to
participate, or if my family composition changes (e.g. a birth or death), I will notify the Refugee
Processing Center and/or Resettlement Support Center as soon as possible.
_____ I have read this information letter and DO NOT wish to participate in the U.S.
Department of State’s resettlement program. I understand that I will be unable to reverse my
decision beyond ten days after the date on which my SIV is issued. Even though I choose to
decline State Department-funded benefits, I understand that I may still qualify for certain ORRfunded
benefits.
By
signing this form, I acknowledge that I have read the U.S. State Department letter and the
accompanying Frequently Asked Questions and 17 Things You Need to Know about Resettling in
the United States. I understand that resettlement benefits vary from one location to another, and
that luxury items (including TVs, radios, telephones, DVD players, computers, vacuums, bicycles,
cars, or air conditioners), professional-level employment, and medical insurance are not
guaranteed. I also understand that housing assistance funding is not guaranteed by the U.S. State
Department beyond my first 30 days in the United States.
Petitioner’s Case Number: ______________________________
