Telecode: 4-digit code that represents characters in some non-Roman alphabet names.

Provide the following information: 

Personal Information 2

Enter all nationalities you currently hold or have previously held, regardless of whether you have formally and/or legally relinquished the nationality. If the country is no longer a nationality, select the associated country used for that location.

Provide the following information:

Permanent resident: Any individual who has been legally granted by a country/region permission to live and work without time limitation in that country/region.
The ID number given to you by your country.

Travel Information

Principal Applicant Information

Principal Applicant Information

Principal Applicant Information

Principal Applicant Information

Provide a complete itinerary for your travel to the U.S. 

Address where you will stay in the U.S. 

Provide the following information

Provide the following information

Travel Companions Information

Previous U.S. Travel Information

Previous U.S. Visas

8-digit number displayed in red on the lower right hand side of your visa. Last 12-digits for a Border Crossing Card in the machine readable zone.
Ten-Printed: You have provided fingerprints for all your fingers, as opposed to having provided only two fingerprints.

Address and Phone Information


Social Media

Do you have a social media prescence?

Select from the list below each social media platform you have used within the last five years. 

  • ONLY include username or handle
  • DO NOT provide your passwords

If you have not used any of the social media platforms in the last 5 years, select 'NONE.'

Passport Information

Travel document should be a valid, unexpired passport or other valid, unexpired documentation that is sufficient to establish your identity and nationality.
This is an inventory control number which can be located in different places in a passport depending on the country of origin. Please contact your passport issuing authority if you are unable to determine if your passport contains a Passport Book Number.

Where was the Passport/Travel Document Issued?

Passport/Travel Document must have at least 6 months of validity beyond the date of your visa application and/or your arrival in the United States.

U.S. Point of Contact Information

Contact Person or Organization in the United States (Optional IF you DON'T know)

Point of contact in the U.S. can be any individual in the U.S. who knows you and can verify, if necessary, your identity.

You may enter the name of the store, company, or organization you plan to visit during your trip if you don't know personally anyone in the U.S. 

Given Names

Address and Phone Number of Point of Contact

Family Information: Relatives

Father's Full Name and Date of Birth

Mother's Full Name and Date of Birth

Immediate relatives can be fiancé/fiancée, spouse (husband/wife), child (son/daughter), or sibling (brother/sister).

Former Spouse

Deceased Spouse

Enter Current Spouse Information/Civil Union Partner/Common Law Marriage.
Full Name (For Spouse, include Maiden Name)

Present Work/Education/Training Information

Note: Provide the following information concerning your current employment or education. 

Answer YES if you have ever attended, for any length of time, a highschool or secondary (or its equivalent in your country) or college, university, graduate school, a doctoral program, or a vocational program.

Provide the following information

Security and Background

For the following questions, a Visa may not be issued to persons who are within specific categories defined by law as inadmissible to the United States (except when a waiver is obtained in advance). Are any of the following applicable to you? 

  1. Do you have a communicable disease of public health significance? (Such diseases include chancroid, gonorrhea, granuloma inguinale, infectious leprosy, lymphogranuloma, venereum, infectious stage syphilis, active TB, and other diseases determined by the Department of Health and Human Services.)
  2. Do you have a mental or physical disorder that poses or is likely to pose a threat to the safety or welfare of yourself or others?
  3. Are you or have you ever been a drug abuser or addict?
  4. Have you ever been arrested or convicted for any offense or crime, even though subject of a pardon, amnesty, or other similar action?
  5. Have you ever violated, or engaged in conspiracy to violate, any law relating to controlled substances?
  6. Are you coming to the United States to engage in prostitution or unlawful commercialized vices?
  7. Have you ever been involved, or do you seek to engage in money laundering?
  8. Have you ever committed or conspired to commit a human trafficking offense?
  9. Have you ever knowingly aided, abetted, assisted or colluded with an individual who has committed a severe human trafficking offense?
  10. Are you the spouse, son, or daughter of an individual who has committed or conspired to commit a human trafficking offense in the U.S. or outside the U.S. and knowingly benefitted within the last 5 years from the trafficking activities?
  11. Do you seek to engage in espionage, sabotage, export control violations, or any other illegal activity while in the U.S.?
  12. Do you seek to engage in terrorist activities while in the U.S. or have you ever engaged in terrorist activities?
  13. Have you ever or do you intend to provide financial assistance or other support to terrorist or terrorist organizations?
  14. Are you a member of representative of a terrorist organization?
  15. Are you the spouse, son, or daughter of an individual who has engaged in terrorist activity, including providing financial assistance or other support to terrorists in the last 5 years?
  16. Have you ever ordered, incited, committed, assisted, or otherwise participated in genocide?
  17. Have you ever committed, ordered, incited, assisted, or otherwise participated in torture?
  18. Have you ever committed, ordered, incited, assisted, or otherwise participated in extrajudicial killings, political killings, or other acts or violence?
  19. Have you ever engaged in the recruitment or the use of child soldiers?
  20. Have you ever, while serving as a government official, been responsible for or directly carried out, at any time, particularly severe violations or religious freedom?
  21. Have you ever been directly involved in the establishment or enforcement of population controls forcing a woman/man to undergo an abortion/sterilization against her/his free choice?
  22. Have you been directly involved in the coercive transplantation of human organs or bodily tissue?
  23. Have you ever sought to obtain or assist others to obtain a visa, entry into the U.S., or any other U.S. immigration benefit by fraud or other unlawful means?
  24. HAVE YOU ever been removed or deported from any country?
  25. Have you ever withheld custody or a U.S. citizen child outside the U.S. from a person granted legal custody by a U.S. Court?
  26. Have you voted in the U.S. in violation of any law or regulation?
  27. Have you ever renounced U.S. citizenship for the purposes of avoiding taxation?
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