If you checked this block, no further information is required. Sign and date below and forward this form to Win-field Village Cooperative, 425 Paddock Dr. West, Savoy, IL 61874. If this block is check on behalf of a child, the adult who will reside in the assisted unit and who is responsible for the child should sign below.

(i) A noncitizen lawfully admitted for permanent residence, as defined by section 101 (a) (20) of the Immigration and Nationality Act (INA), as an immigrant, as defined by section 101(a) (15) of the INA (8 U.S.C. 1001(a) (20) and 1101(a) (15), respectively) [immigrants]. (This category includes a noncitizen admitted under section 210 or 210A of the INA (8 U.S.C 1160 or 1161) [special agricultural workers], who has been granted lawful temporary resident status). (ii) A noncitizen who enter the United States before January 1, 1972, or such later date as enacted by law, and has continuously maintained residence in the United States since then, and who is not eligible for citizenship, but who is deemed to be lawfully admitted for permanent residence as a result of an exercise of discretion by the Attorney General under section 249 of the INA (8 U.S.C. I259). (iii) A noncitizen who is lawfully present in the United States pursuant to an admission under section 207 of the INA (8 U.S.C 1157) [refugee status]; pursuant to the granting of asylum (which has not been terminated) under section 208 of the INA (8 U.S.C. 1158) [asylum status]; or as a result of being granted conditional entry under section 203(a) (7) of the INA (8 U.S.C. 1153(a) (7)).

If you check this block, no further information is required and the person named above is not eligible for assistance. Sign and date below and forward this form to Winfield Village Cooperative, 425 Paddock Dr. West, Savoy, IL 61874. If this block is checked on behalf of a child, the adult who is responsible for the child should sign and date below.