Online Questionnaire Online Questionnaire, please complete as much as you think is applicable. Surname Mr. Mrs. Ms. Miss Last Name Given Name(s) In a sentence or two - what is your immigration request/question? Birthdate MM DD YYYY Nations where you have permanent residency or citizenship US DL/ID # *If applicable Contact Information Address Address 1 Address 2 City State/Province Zip/Postal Code Country Home Phone Number (###) ### #### Fax Number (###) ### #### Mobile Phone Number (###) ### #### Email U.S. Residential Address Do you have a U.S. Address? Yes No Passport/Visa Information Passport ID # Expiration Date MM DD YYYY Do you have any prior U.S. Visa applications(s)? Yes No Do you have a current valid U.S. Visa? Yes No Multiple Entry? Yes No Has your U.S. Visa ever been cancelled? Yes No Have you every overstayed the duration of a Visa status? Yes No Have you ever been refused entry into the U.S.? Yes No Preferred Consulate for Processing City Country Employment Information // *If applicable Current Employer Information Business Name Start Date MM DD YYYY Your Title Business Address Business Address 1 Business Address 2 Business City Business State Business Zipcode Business Phone Number (###) ### #### Business Fax Number (###) ### #### Business Mobile Phone Number (###) ### #### Current U.S. Employment offer? Yes No Educational Experience Total years as a 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? Yes No Have you ever lied or misrepresented yourself to get any U.S. visa or immigration benefit? Yes No Family Information Marital Status Single Legally Married Separated Divorced Widowed Significant Other/Domestic Partner Do you have any children? Yes No Family members with U.S. citizenship (USC) or permanent residence (LPR)? Yes No Has any parent or grandparent ever lived in the U.S.? Yes No Misc. Add your own additional message below. Thank you! For additional questions, contact us at info@msvisa.com.
