U-Visa Application Request

The City of Charlotte is committed to making our services and programs accessible to all. Upon request, auxiliary aids, written materials in alternative formats, language access and other reasonable accommodations or modifications will be provided. To make a request, please email CMPDUVisa@cmpd.org.

Family Name

Given Name

Middle Name

Other Names (include maiden name/nicknames)

Date of Birth

Gender

Male

Female

Case Number

Email Address

Phone Number

is this a recertification?

Yes

Special Notes and Information on this case

Please use the below field to attach a copy of the current/valid government issued ID (with photo) that states their complete name, date of birth from their country of origin or from the United States.

For recertification purposes, please attach a copy of the original signed I-918 Supplement B form.

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