US Visa Application Form

START NEW APPLICATION

Security Question's Answer (Password):

Personal Information 1

Surnames:

Given Names:

Full Name in Native Alphabet:

Have you ever used other names (i.e., maiden, religious, professional, alias, etc.)?

Yes No

Do you have a telecode that represents your name?

Yes No

Sex:

Marital Status:

Date of Birth:

City of Birth:

Place of Birth:

Personal Information 2

Nationality:

Do you hold or have you held any nationality other than the one indicated above?

Yes No

National Identification Number:

U.S. Social Security Number:

U.S. Taxpayer ID Number:

Address and Phone Information

Home Address (Line 1):

Home Address (Line 2):

City:

State:

Postal Zone/ZIP Code:

Country:

Is your Mailing Address the same as your Home Address?

Yes No

Primary Phone Number:

Secondary Phone Number:

Work Phone Number:

Email Address:

Passport Information

Passport/Travel Document Type:

Passport Book Number:

Country/Authority that Issued Passport/Travel Document:

Where was the Passport/Travel Document Issued?

City:

State/Province (If shown on passport):

Country:

Issuance Date:

Expiration Date:

Have you ever lost a passport or had one stolen?

Yes No

Travel Information

Purpose of Trip to the U.S.:

Specify:

Have you made specific travel plans?

Yes No

Intended Date of Arrival in U.S.:

Intended Length of Stay in U.S.:

Address Where You Will Stay in the U.S. (Street address):

City:

State:

ZIP Code:

Person/Entity Paying for Your Trip:

Persons traveling with you:

Are you traveling as part of a group or organization?

Yes No

Previous U.S. Travel Information

Have you ever been in the U.S.?

Yes No

Do you or did you ever hold a U.S. Driver's License?

Yes No

Have you ever been issued a U.S. Visa?

Yes No

Have you ever been refused a U.S. Visa, been refused admission to the United States, or withdrawn your application for admission at the port of entry?

Yes No

Has anyone ever filed an immigrant petition on your behalf with the United States Citizenship and Immigration Services?

Yes No

U.S. Point of Contact Information

Contact Person or Organization in the United States (You can enter either Person OR Organization):

Relationship to You:

U.S. Street Address (Line 1):

City:

State:

ZIP Code:

Phone no:

Email Address:

Family Information: Relatives

Father's Full Name and Date of Birth:

Mother's Full Name and Date of Birth:

Do you have any immediate relatives, not including parents, in the United States?

Yes No

Do you have any other relatives in the United States?

Yes No

Family Information: Spouse

Spouse's Surnames:

Spouse's Given Names:

Spouse's Date of Birth:

Spouse's Nationality:

Spouse's Place of Birth: City

Country:

Spouse's Address:

Present Work/Education/Training Information

Primary Occupation:

Present Employer or School Name:

Street Address (Line 1):

City:

State:

ZIP Code:

Phone No.:

Country:

Briefly describe your duties:

Previous Work / Training Information

Employer Name:

Street Address (Line 1):

City:

State:

ZIP Code:

Phone No.:

Country:

Job Title:

Supervisor's Surname:

Supervisor's Given Names:

Employment Date From:

Employment Date To:

Briefly describe your duties:

Education Information

Name of Institution:

Street Address (Line 1):

City:

State:

Postal Zone/ZIP Code:

Country:

Course of study:

Date of Attendance From:

Date of Attendance To:

Additional Work/Education/Training Information

Do you belong to a clan or tribe?

Provide a List of Languages You Speak:

Have you traveled to any countries within the last five years?

Have you belonged to, contributed to, or worked for any professional, social, or charitable organization?

Do you have any specialized skills or training?

Have you ever served in the military?

Have you ever been involved with a paramilitary or insurgent group?

Security and Background: Part 1

Do you have a communicable disease of public health significance?

Mental/physical disorder posing threat?

Drug abuser or addict?

Ever arrested or convicted?

Violated controlled substances law?

Coming to US for prostitution or related activity?

Money laundering involvement?

Human trafficking involvement?

Assisting others in human trafficking?

Related to human trafficker and benefited?

Espionage or other illegal activity in US?

Terrorist activities?

Supporting terrorists?

Member of terrorist organization?

Genocide involvement?

Torture involvement?

Extrajudicial killings or violence?

Use of child soldiers?

Religious freedom violations?

Forced abortion or sterilization enforcement?

Coercive organ/tissue transplant?

Fraudulent visa or immigration attempt?

Withholding custody of US citizen child?

Illegal voting in the US?

Renounced US citizenship to avoid tax?

Welcome to the US Visa Application Portal

US Visa Application Form