S.A.V.E. Verification Request for Refugees and Asylees

Note: You must be a Maryland resident in order to fill out this form.

Refugee Agency Contact Name*

Agency Contact Phone Number or Email Address*

Refugee Last Name (enter LNU if no last name exists)*

First Name (enter FNU if no first name exists)*

Middle Name

Date of Birth (mm-dd-yyyy)*

MD License/ID Number (if applicable)

Street Address*

City*

ZIP Code*

Identity Document(s):

Enter data for all that apply (Cannot process without either an I-94, Alien or USCIS number)

I-766 (Employment Authorization Card)

Alien or USCIS Number

Expiration Date (mm-dd-yyyy)

I-94 (Arrival/Departure Record)

(Enter 1-94 number: 11 digits)

Unexpired Foreign Passport

Passport Number

Passport Expiration Date (mm-dd-yyyy)

Other (Enter Alien or I-94 Number)

Alien or USCIS Number (9 digits, enter 0 in front of A# if less than 9)

I-94 Number (11 digits)

Preferrable Appointment Location (Mandatory)

Baltimore

Beltsville

Make sure all applicable fields have the correct number of digits. If a foreign issued passport is available, entering the data from the passport, along with the I-94, Alien or USCIS number will result in a more accurate response from SAVE.

If you have any problems with this form, email sdecal@marylandmva.com.