Online visa questionnaire

Personal Information

Surname (Last Name)
Mr.Mrs.Ms.

Given Name(s)

Name in Native Alphabet

Birth Date (day / month / year)

Birthplace (city, province, or state, country)

Current Nationalities
1st

2nd

Social Security No.

US DL/ID#

Contact Information

Address 1

Address 2

City

State/Province

Zip Code

Country

Phone Number

Fax Number

Mobile

Email

U.S. Residential Address

Do you have a U.S. address?
YesNo

Passport/Visa Information

Passport/ID#

Expiration Date (day / month / year)

Prior U.S. visa application(s)?
YesNo

Currently valid US visa?
YesNo

Multiple Entry?
YesNo

Has your U.S. visa ever been cancelled?
YesNo

Have you ever overstayed the duration of a visa status?
YesNo

Have you ever been refused entry into the U.S.?
YesNo

Preferred Consulate for Processing Abroad
City

Country

Employment Information

Current Employer Information

Business Name

Start Date (day / month / year)

Your Title

Business Address
Address 1

Address 2

Business City

Business State

Business Zip Code

Phone Number

Fax Number

Mobile

Email

Current U.S. Employment Offer?
YesNo

Educational Experience

Total years as student

University

Degree

Specialization

Graduation Year

University #2

Degree #2

Specialization #2

Graduation Year #2

Inadmissibility Information

Have you ever been arrested or convicted anywhere in the world?
YesNo

Have you ever lied or misrepresented yourself to get any U.S. visa or immigration benefit?
YesNo

Family Information

Marital Status
SingleSignificant Other/Domestic PartnerLegally MarriedSeparatedDivorcedWidowed

Children
YesNo

Number of children

Family members with US citizenship (USC) or permanent residence (LPR)?
YesNo

Has any parent or grandparent ever lived in the USA
YesNo

Misc

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