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Nonimmigrant Visa Application
OMB CONTROL NUMBER: 1405-0182
FORM NUMBER: DS-160
EXPIRATION DATE: 07/31/2011
Personal Information 1
ESTIMATED BURDEN: 75 MIN
NOTE: Data on this page must match the information as it is written in your passport.
Surnames (e.g., FERNANDEZ GARCIA) Help: Surnames
Enter all surnames as listed in your passport.If only one name is listed in your passport,enter that surname.
Given Names (e.g., JUAN MIGUEL) Help: Given Names
If your passport does not include a givenname, please enter ‘FNU’ in Given Names.
Q: Have you ever used other names (i.e., maiden, religious, professional, alias,etc.)?
Help: Given Names
A: Yes No
Other Surname Used
If you only have other surnames to enter,enter the same given names as above.Conversely, if you only have other givennames to enter, enter the same surname asabove.
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
Does Not Apply Help: Date of Birth
Sex Marital StatusIf day or month is unknown, enter as shown inpassport.
Male Female - SELECT ONE -
Date of Birth (Format: DD-MMM-YYYY)
City of Birth
State/Province of Birth Does Not Apply Help: Country of Birth
Country of Birth
The name of the country should be the namethat is currently in use for the place where youwere born.
Nonimmigrant Visa Application
Personal Information 2Nationality
Q: 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
Q: Do you hold a passport for the nationality above?
A: Yes No
If yes, provide the following information:
Passport Number
Other nationality
Q: Do you hold a passport for the nationality above?
A: Yes No
If yes, provide the following information:
Passport Number
Help: Identification Numbers
National Identification Number
Does Not Apply
U.S. Social Security Number
Does Not Apply
U.S. Taxpayer ID Number
Does Not Apply
If you do not have a NationalIdentification Number, U.S. SocialSecurity Number, or U.S. TaxpayerID Number, then check ‘Does NotApply’.
Nonimmigrant Visa Application
Address and Phone Information
Home Address
Street Address (Line 1)
Street Address (Line 2) *Optional
City
State/Province
Does Not Apply
Postal Zone/ZIP Code
Does Not Apply
Country
Mailing Address
Q: Is your Mailing Address the same as your HomeAddress? (This is the address to which yourpassport will be sent if you qualify for a visa).
A: Yes No
Street Address (Line 1)
Street Address (Line 2) *Optional
City
State/Province
Does Not Apply
Postal Zone/ZIP Code
Does Not Apply
Country
Phone
Home Phone Number
Work Phone Number
Does Not Apply
Work Fax Number
Does Not Apply
Mobile/Cell Phone Number
Does Not Apply
Email Address
Email Address
Does Not Apply
(e.g., [email protected])
Nonimmigrant Visa Application
Passport Information
Passport Number
Passport Book Number Help: Passport Book Number
Does Not Apply
Country/Authority that Issued Passport
Where was the Passport Issued?
City
State/Province *If shown on passport
Country
The Passport Book Number iscommonly called the inventorycontrol number. You may or maynot have a Passport Book Numberon your passport. The location ofthe Passport Book Number on yourpassport may vary depending onthe country that issued yourpassport. Please contact yourpassport issuing authority if you areunable to determine whether or notyour passport contains a PassportBook Number.
Issuance Date Expiration Date Help: Expiration Date
(Format: DD-MMM-YYYY) (Format: DD-MMM-YYYY)
In most cases your passport musthave at least six months of validitybeyond the date of your visaapplication and/or your arrival in theUnited States.
Q: Have you ever lost a passport or had one stolen?
A: Yes No If yes, provide the following information:
Passport Number Passport Number
Does Not Apply Does Not Apply
Country/Authority that Issued Passport Country/Authority that Issued Passport
Nonimmigrant Visa Application
Travel Information
NOTE: Provide the following information concerning your travel plans.
Q: 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 Given Names of Principal Applicant
Purpose of Trip to U.S.-SELECT ONE-Other - Specify-SELECT ONE-Application Receipt/Petition Number
Principal Applicant’s SEVIS ID
Principal Applicant’s Company Name
Purpose of Trip to U.S.-SELECT ONE-Other - Specify-SELECT ONE-Application Receipt/Petition Number
Principal Applicant’s SEVIS ID
All visitors for business orpleasure are principalapplicants, even if you aretraveling with your family. Ifyou are coming to the UnitedStates in a category of visathat permits you to work, study,or get married, you are theprincipal applicant. You are notthe principal applicant if youare accompanying yourspouse or parent who iscoming to the United States ina category of visa that permitsthem to work, study, or getmarried.
Help: Application Receipt/Petition NumberUsed if trip purpose is Fiancé/ Spouse of U.S. Citizen(K) or if applicant is not Principal and Other Specify isTemporary Employee (H1, H2), Trainee (H3), Intra-company Transfer (L), Spouse/Child of PermanentResident (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 purposeis Student/Exchange (F,J,M,Q)
Help: Principal Applicant’s Company Name
Only used if applicant is not Principal and trip purposeOther-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)
Nonimmigrant Visa Application
Travel Information
Person/Entity Paying for Your Trip: -SELECT ONE-
Help: Payer – If SELF, then skip Payer information. Otherwise provide information for either OTHER PERSON or COMPANY/ORGANIZATION.
Other Person Paying for Your TripSurnames:
Given Names:
Email Address:
(e.g., [email protected]) Does Not Apply
Telephone Number:
Relationship to You: -SELECT ONE-
Company/Organization Paying for Your Trip
Name of Company/Organization Paying for Your Trip
Telephone Number:
Relationship to You: -SELECT ONE-
Q: 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: Does Not Apply
Postal Zone/Zip Code: Does Not Apply
Country:
Q: 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
(DD-MMM-YYYY)
Intended Stay Length
SELECT ONE
Yes Specific Travel Plans
Date of Arrival in the U.S.
(DD-MMM-YYYY)
Arrival Flight (if known):
Arrival City
Date of Departure from the U.S.
(DD-MMM-YYYY)
Departure Flight (if known):
Departure City
Help: Travel Plans
If you are unsure of yourDate of Arrival in theU.S. or Date ofDeparture from U.S.,please provide anestimate.
Locations You Plan to Visit in the U.S. (Only required if Specific Travel Plans have been made)
Nonimmigrant Visa Application
Travel Companions InformationNOTE: Provide the following travel companion information.
Q: Are there other persons traveling with you?
A: Yes No
Q: 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
Given Names of Person Traveling With You
Relationship with Person
-SELECT ONE-
Surnames of Person Traveling With You
Given Names of Person Traveling With You
Relationship with Person
-SELECT ONE-
Surnames of Person Traveling With You
Given Names of Person Traveling With You
Relationship with Person
-SELECT ONE-
Surnames of Person Traveling With You
Given Names of Person Traveling With You
Relationship with Person
-SELECT ONE-
Surnames of Person Traveling With You
Given Names of Person Traveling With You
Relationship with Person
-SELECT ONE-
Surnames of Person Traveling With You
Given Names of Person Traveling With You
Relationship with Person
-SELECT ONE-
Surnames of Person Traveling With You
Given Names of Person Traveling With You
Relationship with Person
-SELECT ONE-
Surnames of Person Traveling With You
Given Names of Person Traveling With You
Relationship with Person
-SELECT ONE-
Nonimmigrant Visa Application
Previous U.S. Travel Information
NOTE: Provide the following previous U.S. travel information. Provide complete and accurate information to all questionsthat require an explanation.
Q: Have you ever been in the U.S.? Q: 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
(DD-MMM-YYYY)
Length of Stay
SELECT ONE
Date of Arrival
(DD-MMM-YYYY)
Length of Stay
SELECT ONE
Date of Arrival
(DD-MMM-YYYY)
Length of Stay
SELECT ONE
Date of Arrival
(DD-MMM-YYYY)
Length of Stay
SELECT ONE
Date of Arrival
(DD-MMM-YYYY)
Length of Stay
SELECT ONE
Provide the information on your previous U.S. Driver’s Licenses:
Driver’s License Number
Do Not Know
State of Driver’s License
Driver’s License Number
Do Not Know
State of Driver’s License
Driver’s License Number
Do Not Know
State of Driver’s License
Q:Have you ever beenissued a U.S. Visa?
YesA:
No
Date Last Visa Was Issued
Visa Number
Not Known
Q:Applying for thesame type of Visa?
YesA:
No
Q:Have you ever beenten-printed?
YesA:
No
Q:Applying in the same country where the above visawas issued and is this your country of residence?
A: Yes No
Q: 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:
Q:Have you ever been refused a U.S. Visa oradmission to the U.S., or withdrawn your applicationfor admission at the point of entry?
A: Yes No If yes, explain:
Q: Has your US Visa ever been cancelled or revoked?
A: Yes No If yes, explain:
Nonimmigrant Visa Application
U.S. Point of Contact Information
Contact person or Organization in the United States Help: Contact
Contact Person
Surnames
Given Names Do Not Know
Your U.S. point of contactcan be any individual inthe U.S. who knows youand can verify, ifnecessary, 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)
(e.g., 55555 or 55555-5555)
Phone Number
(e.g., 555-555-5555)
Email Address
(e.g., [email protected])
Nonimmigrant Visa Application
Family Information: Relatives
Father’s Full Name and Date of Birth
Surnames:
Do Not Know
Given Names:
Do Not Know
Date of Birth
(DD-MMM-YYYY)
Do Not Know
Q: Is your father in the U.S.?
A: Yes No
If yes, select your father’s status.
Father’s Status
-SELECT ONE-
Mother’s Full Name and Date of Birth
Surnames:
Do Not Know
Given Names:
Do Not Know
Date of Birth
(DD-MMM-YYYY)
Do Not Know
Q: Is your mother in the U.S.?
A: Yes No
If yes, select your mother’s status.
Mother’s Status
-SELECT ONE-
Q:Do you have any immediaterelatives, not including parents, inthe United States?
A: Yes No
Q:Do you have any other relatives inthe United States?
A: Yes No
Help: Immediate Relatives
Means fiancé, spouse,child, or sibling.
Provide Information About Your Immediate Relatives in the United States
Surnames:
Given Names
Relationship to you: -SELECT ONE-
Relative’s Status -SELECT ONE-
Surnames:
Given Names
Relationship to you: -SELECT ONE-
Relative’s Status -SELECT ONE-
Surnames:
Given Names
Relationship to you: -SELECT ONE-
Relative’s Status -SELECT ONE-
Surnames:
Given Names
Relationship to you: -SELECT ONE-
Relative’s Status -SELECT ONE-
Surnames:
Given Names
Relationship to you: -SELECT ONE-
Relative’s Status -SELECT ONE-
Surnames:
Given Names
Relationship to you: -SELECT ONE-
Relative’s Status -SELECT ONE-
Surnames:
Given Names
Relationship to you: -SELECT ONE-
Relative’s Status -SELECT ONE-
Surnames:
Given Names
Relationship to you: -SELECT ONE-
Relative’s Status -SELECT ONE-
Nonimmigrant Visa Application
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 Nationality
Spouse’s Date of Birth
(DD-MMM-YYYY) Spouse’s Place of Birth
City
Country
Spouse's Address
Spouse’s Address
-SELECT ONE- Provide the following information if spouse’s address is other.
Street Address (Line 1):
U.S. Street Address (Line 2) *Optional:
City:
State/Province: Does Not Apply
Postal Zone/ZIP Code: Does Not Apply
Country:
Date and Place of Marriage
Date: (DD-MMM-YYYY)
City:
State: Does Not Apply
Country:
Nonimmigrant Visa Application
Present Work/Education/Training Information
NOTE: Provide the following information concerning your current employment or education.
Primary Occupation
-SELECT ONE-
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
Does Not Apply
Postal Zone/Zip Code
Does Not Apply
Country
Monthly Salary in Local Currency (if employed)
Does Not Apply
Briefly describe your duties:
Nonimmigrant Visa Application
Previous Work/Education/Training Information
Q: 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: Does Not Apply
Telephone Number: Postal Zone/ZIP Code: Does Not Apply
Country:
Employment Date From Employment Date To
(DD-MMM-YYYY) (DD-MMM-YYYY)
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: Does Not Apply
Telephone Number: Postal Zone/ZIP Code: Does Not Apply
Country:
Employment Date From Employment Date To
(DD-MMM-YYYY) (DD-MMM-YYYY)
Briefly describe you duties:
Nonimmigrant Visa Application
Previous Work/Education/Training Information
Q: 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
Street Address Line 1
Street Address Line 2 *Optional
City:State: Does Not ApplyPostal Zone/ZIP Code: Does Not Apply
Country:Course of Study:
Attendance Date From Attendance Date To
(DD-MMM-YYYY) (DD-MMM-YYYY)
Name of Institution
Street Address Line 1
Street Address Line 2 *Optional
City:State: Does Not ApplyPostal Zone/ZIP Code: Does Not Apply
Country:Course of Study:
Attendance Date From Attendance Date To
(DD-MMM-YYYY) (DD-MMM-YYYY)
Name of Institution
Street Address Line 1
Street Address Line 2 *Optional
City:State: Does Not ApplyPostal Zone/ZIP Code: Does Not Apply
Country:Course of Study:
Attendance Date From Attendance Date To
(DD-MMM-YYYY) (DD-MMM-YYYY)
Name of Institution
Street Address Line 1
Street Address Line 2 *Optional
City:State: Does Not ApplyPostal Zone/ZIP Code: Does Not Apply
Country:Course of Study:
Attendance Date From Attendance Date To
(DD-MMM-YYYY) (DD-MMM-YYYY)
Name of Institution
Street Address Line 1
Street Address Line 2 *Optional
City:State: Does Not ApplyPostal Zone/ZIP Code: Does Not Apply
Country:Course of Study:
Attendance Date From Attendance Date To
(DD-MMM-YYYY) (DD-MMM-YYYY)
Name of Institution
Street Address Line 1
Street Address Line 2 *Optional
City:State: Does Not ApplyPostal Zone/ZIP Code: Does Not Apply
Country:Course of Study:
Attendance Date From Attendance Date To
(DD-MMM-YYYY) (DD-MMM-YYYY)
Nonimmigrant Visa Application
Additional Work/Education/Training Information
NOTE: Provide the following work, education, or training related information. Provide complete and accurate informationto all questions that require an explanation.
Q: Do you belong to a clan or tribe? If yes, please provide the clan or tribe name.
A: Yes No
Q: 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:
Q: 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:
Q: Do you have any specialized skills or training in firearms, explosives, nuclear, biological, or chemical experience?
A: Yes No If yes, explain
Q: Have you been involved with a paramilitary, vigilante, rebel, guerrilla, or insurgent organization?
A: Yes No If yes, explain
Nonimmigrant Visa Application
Additional Work/Education/Training Information
Q: Have you ever served in the military?
A: Yes No If yes, provide the information below.
Name of the Country
Branch of Service
Rank/Position
Military Specialty
Date of Service From
(DD-MMM-YYYY)
Date of Service To
(DD-MMM-YYYY)
Name of the Country
Branch of Service
Rank/Position
Military Specialty
Date of Service From
(DD-MMM-YYYY)
Date of Service To
(DD-MMM-YYYY)
Name of the Country
Branch of Service
Rank/Position
Military Specialty
Date of Service From
(DD-MMM-YYYY)
Date of Service To
(DD-MMM-YYYY)
Name of the Country
Branch of Service
Rank/Position
Military Specialty
Date of Service From
(DD-MMM-YYYY)
Date of Service To
(DD-MMM-YYYY)
Nonimmigrant Visa Application
Security and Background: Medical and Health Information
NOTE: Provide the following security and background information. Provide complete and accurate information to allquestions that require an explanation. A visa may not be issued to persons who are within specific categoriesdefined by law as inadmissible to the United States (except when a waiver is obtained in advance). Are any ofthe following applicable to you? While a YES answer does not automatically signify ineligibility for a visa, if youanswer YES you may be required to personally appear before a consular officer.
Q: Do you have a communicable disease of public health significance such as tuberculosis (TB)?
A: Yes No If yes, explain.
Q:Do you have a mental or physical disorder that poses or is likely to pose a threat to the safety or welfare ofyourself or others?
A: Yes No If yes, explain.
Q: Are you or have you ever been a drug abuser or addict?
A: Yes No If yes, explain.
Nonimmigrant Visa Application
Security and Background: Criminal Information
NOTE: Provide the following security and background information. Provide complete and accurate information to allquestions that require an explanation. A visa may not be issued to persons who are within specific categoriesdefined by law as inadmissible to the United States (except when a waiver is obtained in advance). Are any ofthe following applicable to you? While a YES answer does not automatically signify ineligibility for a visa, if youanswer YES you may be required to personally appear before a consular officer.
Q:Have you ever been arrested or convicted for any offense or crime, even though subject of a pardon, amnesty, orother similar action?
A: Yes No If yes, explain.
Q: Have you ever violated, or engaged in a conspiracy to violate, any law relating to controlled substances?
A: Yes No If yes, explain.
Q:Are you coming to the United States to engage in prostitution or unlawful commercialized vice or have you beenengaged in prostitution or procuring prostitutes within the past 10 years?
A: Yes No If yes, explain.
Q: Have you ever been involved in, or do you seek to engage in, money laundering?
A: Yes No If yes, explain.
Nonimmigrant Visa Application
Security and Background: Security Information
NOTE: Provide the following security and background information. Provide complete and accurate information to allquestions that require an explanation. A visa may not be issued to persons who are within specific categoriesdefined by law as inadmissible to the United States (except when a waiver is obtained in advance). Are any ofthe following applicable to you? While a YES answer does not automatically signify ineligibility for a visa, if youanswer YES you may be required to personally appear before a consular officer.
Q:Do you seek to engage in espionage, sabotage, export control violations, or any other illegal activity while in theUnited States?
A: Yes No If yes, explain.
Q:Do you seek to engage in terrorist activities while in the United States or have you ever engaged in terroristactivities?
A: Yes No If yes, explain.
Q: Have you ever or do you intend to provide financial assistance or other support to terrorist organizations?
A: Yes No If yes, explain.
Q: Are you a member or representative of a terrorist organization?
A: Yes No If yes, explain.
Nonimmigrant Visa Application
Security and Background: Security Information
NOTE: Provide the following security and background information. Provide complete and accurate information to allquestions that require an explanation. A visa may not be issued to persons who are within specific categoriesdefined by law as inadmissible to the United States (except when a waiver is obtained in advance). Are any ofthe following applicable to you? While a YES answer does not automatically signify ineligibility for a visa, if youanswer YES you may be required to personally appear before a consular officer.
Q: Have you ever ordered, incited, committed, assisted, or otherwise participated in genocide?
A: Yes No If yes, explain.
Q: Have you ever ordered, incited, committed, assisted, or otherwise participated in torture?
A: Yes No If yes, explain.
Q:Have you ordered, incited, committed, assisted, or otherwise participated in extrajudicial killings, political killings,or other acts of violence?
A: Yes No If yes, explain.
Q:Have you, while serving as a government official, been responsible for or directly carried out, at any time,particularly severe violations of religious freedom?
A: Yes No If yes, explain.
Nonimmigrant Visa Application
Security and Background: Immigration Law Violation Information
Q: Have you ever been the subject of a removal or deportation hearing?
A: Yes No If yes, explain.
Q:Have you ever sought to obtain or assist others to obtain a visa, entry into the United States, or any other UnitedStates immigration benefit by fraud or willful misrepresentation or other unlawful means?
A: Yes No If yes, explain.
Q: Have you ever failed to attend a hearing on removability or inadmissibility within the last five years?
A: Yes No If yes, explain.
Q:Have you ever been unlawfully present, overstayed the amount of time granted by an immigration official orotherwise violated the terms of a U.S. visa?
A: Yes No If yes, explain.
Nonimmigrant Visa Application
Security and Background: Miscellaneous Information
Q:Have you ever withheld custody of a U.S. citizen child outside the United States from a person granted legalcustody by a U.S. court?
A: Yes No If yes, explain.
Q: Have you voted in the United States in violation of any law regulation?
A: Yes No If yes, explain.
Q: Have you ever renounced United States citizenship for the purpose of avoiding taxation?
A: Yes No If yes, explain.
Q:Have you ever attended a public elementary school on student (F) status or a public secondary school afterNovember 30, 1996 without reimbursing the school?
A: Yes No If yes, explain.
Nonimmigrant Visa Application
Temporary Worker Visa Information
NOTE: You have indicated that the purpose of your trip to the U.S. is to work temporarily. Provide the followinginformation concerning your employer.
Help: ApplicationReceipt/PetitionNumber
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)
$
Q: 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)
Your applicationreceipt/petition numberwas given to you by theDepartment of HomelandSecurity’s United StatesCitizenship andImmigration Services(USCIS) after you filedyour petition application ata USCIS Service Center.The applicationreceipt/petition number is13 characters long andthe first three charactersare letters.
Nonimmigrant Visa Application
Sign and Submit
Preparer of the Application
Q: 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: Does Not Apply
Organization Name: Does Not Apply
Street Address (Line 1):
Street Address (Line 2) *Optional:
City:
State/Province: Does Not Apply
Postal Zone/Zip Code: Does Not Apply
Country:
Relationship to You:
Applicant Passport Number:DS160