Free Tips to Use The Passport Application Form PDF | WPS Office Blog - Free Printable

Actually, you have not uploaded an image — the text you provided is a *description* or *transcription* of a U.S. Department of State form titled:

> “MENT OF EXIGENT/SPECIAL FAMILY CIRCUMSTANCES JANCE OF A U.S. PASSPORT TO A MINOR UNDER AGE 16”

This appears to be a partial or mis-typed version of the official form:
DS-5525 — “Application for Exigent/Special Family Circumstances for Issuance of a U.S. Passport to a Minor Under Age 16.”

---

## ✔ What This Form Is For

This form is used when one parent or legal guardian cannot appear in person to apply for a U.S. passport for a child under age 16, and the other parent/guardian needs to apply alone due to exigent or special family circumstances (e.g., illness, incarceration, deployment, custody issues, etc.).

It allows the applying parent to submit the application without the non-applying parent’s physical presence — but requires documentation proving the reason.

---

## 📝 How to Fill Out the Form (Based on Your Text)

Here’s how to complete each field based on standard instructions for DS-5525:

---

1. Minor’s Name (Last, First, Middle)

→ Enter the child’s full legal name as it appears on their birth certificate or other proof of citizenship.

---

2. Minor’s Date of Birth (mm/dd/yyyy)

→ Enter the child’s date of birth in this format. Example: `03/15/2018`

---

3. Non-Applying Parent/Guardian’s Name (Last, First, Middle)

→ Enter the full legal name of the parent or guardian who is NOT applying in person.

---

4. Other Names of Non-Applying Parent/Guardian

→ If they’ve used other names (maiden name, alias, etc.), list them here.

---

5. Non-Applying Parent/Guardian’s Date of Birth (mm/dd/yyyy)

→ Their birth date in the same format.

---

6. Non-Applying Parent/Guardian’s Last Known Contact Information

Fill in:
- Street Address
- Apartment (if applicable)
- City, State, ZIP Code
- Country (if outside the U.S.)
- Telephone Number
- E-mail Address

> ⚠️ This info must be current so the State Department can contact them if needed.

---

7. Has any court ever issued an order/decrees regarding custody or travel?

→ Check “Yes” if there’s any court order (divorce decree, custody agreement, restraining order, etc.) that affects the child’s travel or custody.

→ If “Yes”, you MUST attach a complete, signed, and dated copy of the court order with your application.

→ If “No”, check “No”.

---

8. Is the non-applying parent/guardian currently incarcerated?

→ Check “Yes” if they are in jail/prison.

→ If yes, you may need to provide proof (e.g., incarceration letter from facility).

→ If “No”, check “No”.

---

## 🔑 Important Notes & Tips

✔ You must also submit:
- The child’s proof of U.S. citizenship (birth certificate, naturalization certificate, etc.)
- The child’s government-issued ID (if available)
- Your own valid photo ID
- One passport photo of the child
- Form DS-11 (the main passport application form)
- Fee payment

✔ If the non-applying parent is unavailable due to exigent circumstances (like being overseas, hospitalized, deployed, etc.), you may need to submit additional evidence like:
- Medical records
- Military orders
- Incarceration documentation
- Police reports (if applicable)

✔ The non-applying parent can also sign a notarized Form DS-3053 (“Statement of Consent”) instead of using DS-5525 — unless they’re unreachable or unwilling to consent.

---

## ❗ Common Mistakes to Avoid

- Leaving fields blank — all required fields must be completed.
- Not attaching court orders when “Yes” is checked in Question 7.
- Using outdated or incorrect formats for dates (always use mm/dd/yyyy).
- Failing to include supporting documents — applications are often rejected without them.

---

## ✔ Final Step

After completing DS-5525 and gathering all required documents, submit everything in person at a passport acceptance facility (like a post office or clerk of court) along with Form DS-11.

---

## 💡 Summary

You’re filling out Form DS-5525 to request a U.S. passport for a minor under 16 when one parent cannot be present. Complete all fields accurately, especially those about custody and contact info. Attach all required documents — especially court orders or proof of incarceration if applicable.

If you’d like help filling out the actual form with real names/dates, feel free to share the details (privately), and I’ll guide you step-by-step!

Let me know if you need a downloadable version of DS-5525 or instructions for submitting it.