US Visa Application

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General Information

Email address

Applicant Information

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First name(s) or given name(s)

Please ensure that the First name(s) on your passport or travel document match exactly with the information you provide.

Family name(s) or last name(s)

Please ensure that the Family name(s) on your passport or travel document match exactly with the information you provide.

Full name in your native alphabet

Please ensure that the First name(s) on your passport or travel document match exactly with the information you provide.

Gender

Male
Female

Marital Status

Have you ever gone by other names, such as maiden, religious, professional, or alias names?

Have you used a four-letter code to represent your name in a communication system?

Date of Birth

City of Birth

If your place of birth is not listed on your passport, please enter the name of the city/town/village where you were born.

Region

Passport Information

Type of passport/travel document

Passport/Travel Document Number

Enter the passport number exactly as it appears on the passport information page

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Passport Book Number

Doesn't apply

Doesn't apply

Issuing country/authority of the passport/travel document

City

State/Region/Province

Country/Region

Passport Issuance Date

Passport Expiration Date

Have you ever lost a passport or had one stolen?

Country/Region of Origin (Nationality)

Additional Nationalities

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

Other Country/Region of Origin (Nationality)

Are you a permanent resident of a country/region other than your country/region of origin (nationality) as indicated above?

Country

National Identification Number

Doesn't apply

Doesn't apply

Contact Information

Address

Address Line 1

City

State / Province / Region

Country

Is your Mailing Address the same as your Home Address?

Primary Phone Number

Secondary Phone Number

Have you used any other phone number in the last five years?

Have you used any other email address in the last five years?

Employment / Education

Primary Occupation

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Present Employer or School Name

Present Employer or School Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Telephone number

Start Date

Monthly Income In Local Currency

Briefly describe your duties

Were you previously employed?

Have you attended any educational institutions at a secondary level or above?

Security Questions

Have you ever served in the military?

Have you traveled outside your country (not including the United States) in the last 5 years?

Do you have any specialized skills or training, such as firearms, explosives, nuclear, biological, or chemical experience?

Have you ever served in, been a member of, or been involved with a paramilitary unit, vigilante unit, rebel group, guerrilla group, or insurgent organization?

Do you have a communicable disease of public health significance? (Communicable diseases of public significance include chancroid, gonorrhea, granuloma inguinale, infectious leprosy, lymphogranuloma venereum, infectious stage syphilis, active tuberculosis, and other diseases as determined by the Department of Health and Human Services.)

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?

Are you or have you ever been a drug abuser or addict?

Have you ever been arrested or convicted for any offense or crime, even though subject of a pardon, amnesty, or other similar action?

Have you ever violated, or engaged in a conspiracy to violate, any law relating to controlled substances?

Are you coming to the United States to engage in prostitution or unlawful commercialized vice or have you been engaged in prostitution or procuring prostitutes within the past 10 years?

Have you ever been involved in, or do you seek to engage in, money laundering?

Have you ever committed or conspired to commit a human trafficking offense in the United States or outside the United States?

Have you ever knowingly aided, abetted, assisted or colluded with an individual who has committed, or conspired to commit a severe human trafficking offense in the United States or outside the United States?

Are you the spouse, son, or daughter of an individual who has committed or conspired to commit a human trafficking offense in the United States or outside the United States and have you within the last five years, knowingly benefited from the trafficking activities?

Do you seek to engage in espionage, sabotage, export control violations, or any other illegal activity while in the United States?

Do you seek to engage in terrorist activities while in the United States or have you ever engaged in terrorist activities?

Have you ever or do you intend to provide financial assistance or other support to terrorists or terrorist organizations?

Are you a member or representative of a terrorist organization?

Have you ever ordered, incited, committed, assisted, or otherwise participated in genocide?

Have you ever committed, ordered, incited, assisted, or otherwise participated in torture?

Have you committed, ordered, incited, assisted, or otherwise participated in extrajudicial killings, political killings, or other acts of violence?

Have you ever engaged in the recruitment or the use of child soldiers?

Have you, while serving as a government official, been responsible for or directly carried out, at any time, particularly severe violations of religious freedom?

Have you ever been directly involved in the establishment or enforcement of population controls forcing a woman to undergo an abortion against her free choice or a man or a woman to undergo sterilization against his or her free will?

Have you ever been directly involved in the coercive transplantation of human organs or bodily tissue?

Have you ever sought to obtain or assist others to obtain a visa, entry into the United States, or any other United States immigration benefit by fraud or willful misrepresentation or other unlawful means?

Have you ever withheld custody of a U.S. citizen child outside the United States from a person granted legal custody by a U.S. court?

Have you voted in the United States in violation of any law or regulation?

Have you ever renounced United States citizenship for the purposes of avoiding taxation?

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 or terrorist organizations, in the last five years?

Have you ever been removed or deported from any country?