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NEWSTART NON IMMIGRANT VISA QUESTIONNAIRE

This questionnaire is for the following non-immigrant visa class:'); document.write(''); document.write('B- Tourist/Business'); document.write('F- Student Academic/Language'); document.write('M- Student Vocational '); document.write('J- Exchange visitor'); document.write('and Extension of stay in US'); document.write(''); document.write(''); document.write(''); document.write('

Type of service required from NEWSTART * $100-DS-160 Form Assistance.Document Preparation/ Appt Scheduling /3 sessions of mock interview B1/B2 Renewal Dropbox $100 $70 Visa Waiver Program Travel Authorization[ESTA] $500 Student Visa Assistance complete package, 3 school comparison ,student loan application & consular processing assistance $300 Student visa assistance, with student loan application and consular processing assistance $350 J1- Exchange Program assistance with consular processing assistance OTHER ( just for information gathering purpose)

US Consulate you will apply for B1/B2 Visa ( City/Country) *

Do you have residency/ right to work in the above country No Yes (if yes provide your overseas address below)

Overseas Address Street name and number

City/ Province /State

Country and Postcode

What is your grandmother\'s name *

Your name exactly as in your passport: Last Name *

First Names *

Gender * Male Female

Civil Status * Never Married Single Married Same Sex Marriage Separated Divorced Annulled Widow De facto (live-in relationship but not married)

Date of Birth * date_range

Birth Place *

Country of Birth *

Country of Citizenship *

Are you a permanent resident of a country/region other than your country/region of origin (nationality) above? * No Yes

Other Permanent Resident Country

Do you have a National ID No Yes

If yes what\'s your National Id number

What is yourTax ID Number (TIN) or (SSN)

Home address *

City *

State/Province *

Country/ Postcode *

Is you mailing address the same as your home address * Yes No

If No what\'s your mailing address

Primary phone/Mobile Number *

Secondary phone/Mobile Number

Work phone/Mobile Number

Have you used additional phone numbers in the last five years? No Yes

If yes: Provide Details

Email Address

Have you used additional email addresses in the last five years? * No Yes

If yes: Provide Details

Do you have a social media presence? * No I don\'t have social media account Yes

Social Media Provider/Platform Facebook Instagram Twitter Reddit Other

Social Media Identifier

If Other: Provide details

Have you used additional social media platforms in the last five years? No Yes

If Yes: Provide details

Passport Number *

Country of issue *

Place of issue *

Date of issue * date_range

Date of expiry * date_range

Do you have another passport from another country No Yes

If yes type details:

Have you ever had a passport lost or stolen No Yes

If yes explain how your passport got lost/stolen start with country of issue and passport number if known

Are you known by any other name * No Yes

If yes: Other Name 1

Reason for Name Change Maiden Name Previous Married Name Name as shown in my birth certificate

Other Name 2

Reason for Name Change Maiden Name Previous Married Name Name as shown in my birth certificate

Purpose of your trip * Tourism Business Medical Treatment F-1 Student Visa J-1 Exchange Program

Give a short description of your tript to the US *

Intended date of travel to USA * date_range

Intended length of stay in USA *

Address where you will stay /address of hotel if applicable

Who will pay for your trip * Self funded Relative Other Person Present Employer US Employer Scholarship Student Loan Other

Are there other person traveling with you * No Yes

If yes provide name/s of your travelling companion 1

Relationship Spouse Child Belong to a group Other

Provide name/s of your travelling companion 2

Relationship Spouse Child Belong to a group Other

Have you ever been in the U.S.? * No Yes

Have you ever been issued a U.S. visa? * No Yes

Are you applying for the same type of visa Yes No

Year your US visa was issued

Has your ever applied for extension of stay in USA * Yes No

Has your ever overstayed your stay in USA * Yes No

Briefly explain the circumstances why you overstayed

Has your U.S. Visa ever been lost or stolen? Yes No

Have you ever been refused a U.S. Visa, or been refused admission to the United States, or withdrawn your application for admission at the port of entry? * Yes No

If yes, how many times you had US visa denied, visa category the year/s of refusal or year you were refused admission to USA

Has anyone ever filed an immigrant petition on your behalf with the USCIS No Yes

visa category + outcome of the petition[ granted,denied,withdrawn]

Briefly explain the source of funds for your trip *

Contact Person Name in the U.S.:

Organization/ Company/ Hotel you will be staying

U.S. Contact address

US contact Email Address

US Contact Phone number

Father\'s First(Given Names) Middle Name Last Name *

Father\'s date of birth * date_range

Father\'s Place of Birth. *

Is your father in the US * No Yes

Mother\'s First(Given Names) Middle Name Last Name *

Mother\'s date of birth * date_range

Mother\'s Place of Birth.

Is your mother in the US No Yes

Other immediate family member in the US

Spouse name if applicable

Spouse Date of Birth date_range

Spouse Place of Birth.

Spouse Email address

Spouse Telephone Number

What is your present occupation * Employed Self Employed Retired Student Not Employed

If not employed explain

Primary Occupation/Position

Present Employment/ Name of Business if self employed

Employment Address

Province-Post code+ Country

Name of supervisor

Start Date date_range

End Date date_range

Briefly describe your duties

Monthly salary

Previous Employments/Business

Previous employer address

Primary Occupation/Position

Briefly describe your duties

Name of supervisor

Telephone number

Start Date date_range

End Date date_range

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

Name of Institution *

Address of Institution *

City *

State/ Province *

Country/ Post code *

Course of Study *

Date Start * date_range

Date End * date_range

Other Educational Institution

QUESTIONS FOR STUDENT/ J-1 VISA APPLICANT: SEVIS #

Course of Study in US

Preferred State

Do you want to apply for Student Loan Yes No

If yes: Name of co-signor of your student loan application

Relationship to you

What it the immigration status of your co-signor in the US US Citizen Green Card holder

FOR STUDENT VISA APPLICANT ONLY PROVIDE 3 REFERENCES

Reference 1: First Name + Last Name and address

Telephone

Email address

Reference 2: First Name + Last Name and address

Telephone

Email address

Reference 3: First Name + Last Name and address

Telephone

Email address

Provide a list of language you speak *

Have you traveled to any countries * No Yes

List of countries you have traveled

List of membership you belonged to, contributed to, or worked for any professional, social, or charitable organization

Do you have urgent and compelling reason to travel to US No Yes

If yes, select reason Medical Emergency-Purpose of travel is to obtain emergency medical care, or to accompany a relative or employer for emergency medical care, or to visit a relative suffering from an immediate, life-threatening medical condition. Funeral/Death-Purpose of travel is to attend the funeral of or make arrangements for repatriating the body of an immediate family member (mother, father, brother, sister, child, grandparent, or grandchild) in the United States. Urgent Business Travel Purpose of travel is to attend to an urgent business matter where the travel requirement could not be predicted in advance. Students or exchange visitors

Explain your compelling reason

If Student or exchange visitor, when is the start date of your course date_range

Is there anything that you think may affect your tourist visa application

Attach Front Page of your passport *

By clicking submit you hereby give NEWSTART Visa Services consent to file your DS-160 application online *

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