Personal Information 1 NOTE: Data on this page must match the information as it is written in your passport. Surnames (e.g., FERNANDEZ GARCIA) Given Names (e.g., JUAN MIGUEL) OMB CONTROL NUMBER: 1405-0182 FORM NUMBER: DS-160 EXPIRATION DATE: 07/31/2011 ESTIMATED BURDEN: 75 MIN Help: Surnames Enter all surnames as listed in your passport. If only one name is listed in your passport, enter that surname. Help: Given Names If your passport does not include a given name, please enter FNU in Given Names. Have you ever used other names (i.e., maiden, religious, professional, alias, etc.)? A: Yes No Other Surname Used Help: Given Names If you only have other surnames to enter, enter the same given names as above. Conversely, if you only have other given names to enter, enter the same surname as above. Other Given Name Used Other Surname Used Other Given Name Used Other Surname Used Other Given Name Used Other Surname Used Other Given Name Used Full Name in Native Alphabet Help: Date of Birth Sex Marital Status Male Female - SELECT ONE - If day or month is unknown, enter as shown in passport. Date of Birth (Format: DD-MMM-YYYY) City of Birth State/Province of Birth Help: Country of Birth Country of Birth The name of the country should be the name that is currently in use for the place where you were born.
Personal Information 2 Nationality Do you hold or have you held a nationality other than the one you have indicated above? A: Yes No If yes, provide the following information: Other nationality Other nationality Do you hold a passport for the nationality above? A: Yes No If yes, provide the following information: Passport Number Do you hold a passport for the nationality above? A: Yes No If yes, provide the following information: Passport Number National Identification Number U.S. Social Security Number Help: Identification Numbers If you do not have a National Identification Number, U.S. Social Security Number, or U.S. Taxpayer ID Number, then check Does Not Apply. U.S. Taxpayer ID Number
Address and Phone Information Home Address Street Address (Line 1) Street Address (Line 2) *Optional Mailing Address Is your Mailing Address the same as your Home Address? (This is the address to which your passport will be sent if you qualify for a visa). A: Yes No Street Address (Line 1) City Street Address (Line 2) *Optional State/Province City Postal Zone/ZIP Code State/Province Country Postal Zone/ZIP Code Country Phone Home Phone Number Work Phone Number Work Fax Number Mobile/Cell Phone Number Email Address Email Address (e.g., emailaddress@example.com)
Passport Information Passport Number Passport Book Number Country/Authority that Issued Passport Where was the Passport Issued? City State/Province *If shown on passport Help: Passport Book Number The Passport Book Number is commonly called the inventory control number. You may or may not have a Passport Book Number on your passport. The location of the Passport Book Number on your passport may vary depending on the country that issued your passport. Please contact your passport issuing authority if you are unable to determine whether or not your passport contains a Passport Book Number. Country Issuance Date Expiration Date Help: Expiration Date (Format: DD-MMM-YYYY) (Format: DD-MMM-YYYY) In most cases your passport must have at least six months of validity beyond the date of your visa application and/or your arrival in the United States. Have you ever lost a passport or had one stolen? A: Yes No If yes, provide the following information: Passport Number Passport Number Country/Authority that Issued Passport Country/Authority that Issued Passport
Travel Information NOTE: Provide the following information concerning your travel plans. Are you the principal applicant? Help: Principal Applicant A: Yes No If no, enter Surname and Given Names of the Principal. Surname of Principal Applicant Purpose of Trip to U.S. Other - Specify Application Receipt/Petition Number Principal Applicant s SEVIS ID Given Names of Principal Applicant Purpose of Trip to U.S. Other - Specify Application Receipt/Petition Number Principal Applicant s SEVIS ID All visitors for business or pleasure are principal applicants, even if you are traveling with your family. If you are coming to the United States in a category of visa that permits you to work, study, or get married, you are the principal applicant. You are not the principal applicant if you are accompanying your spouse or parent who is coming to the United States in a category of visa that permits them to work, study, or get married. Principal Applicant s Company Name Help: Application Receipt/Petition Number Used if trip purpose is Fiancé/ Spouse of U.S. Citizen (K) or if applicant is not Principal and Other Specify is Temporary Employee (H1, H2), Trainee (H3), Intracompany Transfer (L), Spouse/Child of Permanent Resident (V), Extraordinary Person (O), Athlete- Entertainer (P1), Cultural Artist (P3). Help: Principal Applicant s SEVIS ID Only used if applicant is not Principal and trip purpose is Student/Exchange (F,J,M,Q) Help: Principal Applicant s Company Name Only used if applicant is not Principal and trip purpose Other-Specify is Treaty Trader/Investor (E1, E2). Address Where You Will Stay in the U.S. Street Address (Line 1): Street Address (Line 2) *Optional: City: State: Zip Code: (e.g., 55555 or 55555-5555)
Travel Information Person/Entity Paying for Your Trip: Help: Payer If SELF, then skip Payer information. Otherwise provide information for either OTHER PERSON or COMPANY/ORGANIZATION. Other Person Paying for Your Trip Surnames: Given Names: Email Address: (e.g., emailaddress@example.com) Telephone Number: Relationship to You: Company/Organization Paying for Your Trip Name of Company/Organization Paying for Your Trip Telephone Number: Relationship to You: Is the address of the party paying for your trip the same as your Home or Mailing Address? A: Yes No Help: Payer Address Only fill in address if Payer is NOT SELF and different than Home/Mailing Address. Address of Other Person or Company/Organization Paying for Your Trip Street Address (Line 1): Street Address (Line 2) *Optional: City: State/Province: Postal Zone/Zip Code: Country: Have you made specific travel plans? A: Yes No If no, enter Surname and Given Names of the Principal. No Specific Travel Plans Intended Arrival Date Intended Stay Length SELECT ONE Arrival Flight (if known): Arrival City Date of Arrival in the U.S. Yes Specific Travel Plans Date of Departure from the U.S. Departure Flight (if known): Departure City Help: Travel Plans If you are unsure of your Date of Arrival in the U.S. or Date of Departure from U.S., please provide an estimate. Locations You Plan to Visit in the U.S. (Only required if Specific Travel Plans have been made)
Travel Companions Information NOTE: Provide the following travel companion information. Are there other persons traveling with you? A: Yes No Are you traveling as part of a group or organization? If yes, enter the group name. A: Yes No Group name: Surnames of Person Traveling With You Surnames of Person Traveling With You Given Names of Person Traveling With You Given Names of Person Traveling With You Relationship with Person Relationship with Person Surnames of Person Traveling With You Surnames of Person Traveling With You Given Names of Person Traveling With You Given Names of Person Traveling With You Relationship with Person Relationship with Person Surnames of Person Traveling With You Surnames of Person Traveling With You Given Names of Person Traveling With You Given Names of Person Traveling With You Relationship with Person Surnames of Person Traveling With You Relationship with Person Surnames of Person Traveling With You Given Names of Person Traveling With You Given Names of Person Traveling With You Relationship with Person Relationship with Person
Previous U.S. Travel Information NOTE: Provide the following previous U.S. travel information. Provide complete and accurate information to all questions that require an explanation. Have you ever been in the U.S.? Do you or did you ever hold a U.S. Driver s License? A: Yes No A: Yes No Provide information on your last five U.S. visits: Date of Arrival Date of Arrival Date of Arrival Date of Arrival Date of Arrival Length of Stay SELECT ONE Length of Stay SELECT ONE Length of Stay SELECT ONE Length of Stay SELECT ONE Length of Stay SELECT ONE Provide the information on your previous U.S. Driver s Licenses: Driver s License Number Driver s License Number Driver s License Number State of Driver s License Do Not Know State of Driver s License Do Not Know State of Driver s License Do Not Know Have you ever been issued a U.S. Visa? Date Last Visa Was Issued Applying for the same type of Visa? Have you ever been ten-printed? A: Yes No Visa Number Not Known A: Yes No A: Yes No Applying in the same country where the above visa was issued and is this your country of residence? A: Yes No Have you ever been refused a U.S. Visa or admission to the U.S., or withdrawn your application for admission at the point of entry? A: Yes No If yes, explain: Has your U.S. Visa ever been lost or stolen? A: Yes No If yes, enter the year: Enter year of lost/stolen U.S. Visa: Has your US Visa ever been cancelled or revoked? A: Yes No If yes, explain:
U.S. Point of Contact Information Contact person or Organization in the United States Contact Person Surnames Given Names Do Not Know Help: Contact Your U.S. point of contact can be any individual in the U.S. who knows you and can verify, if necessary, your identity. Organization Name Do Not Know Relationship to You - SELECT ONE - Address and Phone Number of Point of Contact U.S. Street Address (Line 1) U.S. Street Address (Line 2) *Optional City State ZIP Code (if Known) Phone Number Email Address (e.g., 55555 or 55555-5555) (e.g., 555-555-5555) (e.g., emailaddress@example.com)
Family Information: Relatives Father s Full Name and Date of Birth Surnames: Given Names: Date of Birth Do Not Know Father s Status Do Not Know Do Not Know Is your father in the U.S.? A: Yes No If yes, select your father s status. Mother s Full Name and Date of Birth Surnames: Given Names: Date of Birth Do Not Know Mother s Status Do Not Know Do Not Know Is your mother in the U.S.? A: Yes No If yes, select your mother s status. Do you have any immediate relatives, not including parents, in the United States? A: Yes No Do you have any other relatives in the United States? A: Yes No Provide Information About Your Immediate Relatives in the United States Help: Immediate Relatives Means fiancé, spouse, child, or sibling. Surnames: Given Names Relationship to you: Relative s Status Surnames: Given Names Relationship to you: Relative s Status Surnames: Given Names Relationship to you: Relative s Status Surnames: Given Names Relationship to you: Relative s Status Surnames: Given Names Relationship to you: Relative s Status Surnames: Given Names Relationship to you: Relative s Status Surnames: Given Names Relationship to you: Relative s Status Surnames: Given Names Relationship to you: Relative s Status
Family Information: Spouse NOTE: Enter current spouse information. If divorced, enter previous spouse information. Spouse's Full Name (include Maiden Name) 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 Spouse s Address Provide the following information if spouse s address is other. Street Address (Line 1): U.S. Street Address (Line 2) *Optional: City: State/Province: Postal Zone/ZIP Code: Country: Date and Place of Marriage Date: City: State: Country:
Present Work/Education/Training Information NOTE: Provide the following information concerning your current employment or education. Primary Occupation Specify Other or Explain Not Employed Present Employer or School Name Present Employer or School Address Street Address (Line 1) Street Address (Line 2) *Optional City State/Province Postal Zone/Zip Code Country Monthly Salary in Local Currency (if employed) Briefly describe your duties:
Previous Work/Education/Training Information Were you previously employed? A: Yes No Help: Previous Employers Provide your employment information for the last five years, if applicable. Employer Name Job Title Employer Street Address Line 1 Supervisor Surnames Employer Street Address Line 2 *Optional Supervisor Given Names City: State: Telephone Number: Postal Zone/ZIP Code: Country: Employment Date From Employment Date To Briefly describe you duties: Employer Name Job Title Employer Street Address Line 1 Supervisor Surnames Employer Street Address Line 2 *Optional Supervisor Given Names City: State: Telephone Number: Postal Zone/ZIP Code: Country: Employment Date From Employment Date To Briefly describe you duties:
Previous Work/Education/Training Information Have you attended any educational institutions other than elementary schools? A: Yes No Help: Previous Institutions Provide information below for institutions attended, not including elementary. Name of Institution Name of Institution Street Address Line 1 Street Address Line 1 Street Address Line 2 *Optional Street Address Line 2 *Optional City: State: Postal Zone/ZIP Code: City: State: Postal Zone/ZIP Code: Country: Course of Study: Attendance Date From Attendance Date To Country: Course of Study: Attendance Date From Attendance Date To Name of Institution Name of Institution Street Address Line 1 Street Address Line 1 Street Address Line 2 *Optional Street Address Line 2 *Optional City: State: Postal Zone/ZIP Code: City: State: Postal Zone/ZIP Code: Country: Course of Study: Attendance Date From Attendance Date To Country: Course of Study: Attendance Date From Attendance Date To Name of Institution Name of Institution Street Address Line 1 Street Address Line 1 Street Address Line 2 *Optional Street Address Line 2 *Optional City: State: Postal Zone/ZIP Code: City: State: Postal Zone/ZIP Code: Country: Course of Study: Attendance Date From Attendance Date To Country: Course of Study: Attendance Date From Attendance Date To
Additional Work/Education/Training Information NOTE: Provide the following work, education, or training related information. Provide complete and accurate information to all questions that require an explanation. Do you belong to a clan or tribe? If yes, please provide the clan or tribe name. A: Yes No Have you traveled to any countries within the last five years? A: Yes No If yes, provide a list of countries visited. Countries visited in the last five years: Have you belonged to, contributed to, or worked for any professional, social, or charitable organization? A: Yes No If yes, provide a list of organizations. Organizations belonged to, contributed to, or worked for: Do you have any specialized skills or training in firearms, explosives, nuclear, biological, or chemical experience? A: Yes No If yes, explain Have you been involved with a paramilitary, vigilante, rebel, guerrilla, or insurgent organization? A: Yes No If yes, explain
Additional Work/Education/Training Information Have you ever served in the military? A: Yes No If yes, provide the information below. Name of the Country Name of the Country Branch of Service Branch of Service Rank/Position Rank/Position Military Specialty Military Specialty Date of Service From Date of Service To Date of Service From Date of Service To Name of the Country Name of the Country Branch of Service Branch of Service Rank/Position Rank/Position Military Specialty Military Specialty Date of Service From Date of Service To Date of Service From Date of Service To
Security and Background: Medical and Health Information NOTE: Provide the following security and background information. Provide complete and accurate information to all questions that require an explanation. 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? While a YES answer does not automatically signify ineligibility for a visa, if you answer YES you may be required to personally appear before a consular officer. Do you have a communicable disease of public health significance such as tuberculosis (TB)? 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?
Security and Background: Criminal Information NOTE: Provide the following security and background information. Provide complete and accurate information to all questions that require an explanation. 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? While a YES answer does not automatically signify ineligibility for a visa, if you answer YES you may be required to personally appear before a consular officer. 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?
Security and Background: Security Information NOTE: Provide the following security and background information. Provide complete and accurate information to all questions that require an explanation. 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? While a YES answer does not automatically signify ineligibility for a visa, if you answer YES you may be required to personally appear before a consular officer. 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 terrorist organizations? Are you a member or representative of a terrorist organization?
Security and Background: Security Information NOTE: Provide the following security and background information. Provide complete and accurate information to all questions that require an explanation. 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? While a YES answer does not automatically signify ineligibility for a visa, if you answer YES you may be required to personally appear before a consular officer. Have you ever ordered, incited, committed, assisted, or otherwise participated in genocide? Have you ever ordered, incited, committed, assisted, or otherwise participated in torture? Have you ordered, incited, committed, assisted, or otherwise participated in extrajudicial killings, political killings, or other acts of violence? Have you, while serving as a government official, been responsible for or directly carried out, at any time, particularly severe violations of religious freedom?
Security and Background: Immigration Law Violation Information Have you ever been the subject of a removal or deportation hearing? 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 failed to attend a hearing on removability or inadmissibility within the last five years? Have you ever been unlawfully present, overstayed the amount of time granted by an immigration official or otherwise violated the terms of a U.S. visa?
Security and Background: Miscellaneous Information 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 regulation? Have you ever renounced United States citizenship for the purpose of avoiding taxation? Have you ever attended a public elementary school on student (F) status or a public secondary school after November 30, 1996 without reimbursing the school?
Temporary Worker Visa Information NOTE: You have indicated that the purpose of your trip to the U.S. is to work temporarily. Provide the following information concerning your employer. Where Do You Intend to Work? Name of Employer Street Address (Line 1) Street Address (Line 2) *Optional City State Zip Code (e.g., 55555 or 55555-5555) Enter monthly salary (in USD) $ Do you have an application receipt/petition number? A: Yes No If yes, provide the following information. Name of Person/Company who Filed Petition Application Receipt/Petition Number (e.g., ABC1234567890) Help: Application Receipt/Petition Number Your application receipt/petition number was given to you by the Department of Homeland Security s United States Citizenship and Immigration Services (USCIS) after you filed your petition application at a USCIS Service Center. The application receipt/petition number is 13 characters long and the first three characters are letters.
DS160 Nonimmigrant Visa Application Sign and Submit Preparer of the Application Did anyone assist you in filling out this application? A: Yes No If yes, provide the Preparer s information below. Preparer Information Surnames: Given Names: Organization Name: Street Address (Line 1): Street Address (Line 2) *Optional: City: State/Province: Postal Zone/Zip Code: Country: Relationship to You: Applicant Passport Number: