US VISA QUESTIONNAIRE
Please answer as much as you can.
Select Application Category
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B1/B2 Tourist, Business
F1- Student Visa
J1- Exchange Program Trainee
J-1 Exchange Program Internship
Extension of Stay/ Change of Status (non-immigrant)
EB2-NIW
Extension of Stay/ Change of Status
Other US visa category
J1-212e Home Residence Waiver
What is your grandmother's first name (mother side)
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First Name
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Last Name
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Middle Name
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Name Exactly in passport
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Date of Birth
*
date_range
Place of Birth
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Country of Birth
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Country of Citizenship
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Are you a permanent resident of a country/region other than your country/region of origin (nationality) above?
Yes
No
Other permanent resident or country of work
Civil Status
Never Married
Single
Married
Same Sex Marriage
Separated
Divorced
Annulled
Widow/widower
De Facto/Common Law (live-in relationship)
Gender
Male
Female
Home Address
City/ Province+ Country+Postcode
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Is you mailing address the same as your home address
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Yes
No
If No what is your mailing address if you are in US write your US address here
Primary Phone Number
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US Phone Number if applicable
Have you used additional phone numbers in the last five years?
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Yes
No
If yes provide details
Email Address
Have you used additional email address in the last five years?
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Yes
No
If yes provide details
Do you have a social media presence
No
Yes
If yes provide Social Media Provider/Platform
Facebook
Instagram
Twitter
YouTube
Other
Social Media Identifier
Passport Number
Date of Issue
date_range
Date of Expiry
date_range
Country of Issue
Have you ever had a passport lost or stolen
No
Yes
If "Yes" provide details
Are you known by any other name
No
Yes
If yes: Other Name 1
Reason for Name Change
Maiden Name
Name as shown in the birth certificate
Previous Married name
Intended length of stay in US
Intended date of travel in US
date_range
Address in the US where you will be staying.
Who will pay for your trip
Self-funded
Relative
Other Person
Scholarship
Student Loan
Employer
Briefly explain the source of funds for this trip
Are there other person traveling with you
No
Yes
If yes: Provide details
Relationship to you
Spouse
Child
Belong to a group
Other
Have you ever been issued a U.S. visa
No
Yes
If yes: Provide details
Have you ever been in the U.S.?
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No
Yes
If yes: Provide details
Has anyone ever filed an immigrant petition on your behalf with the USCIS
No
Yes
If yes: Provide details
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?
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No
Yes
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
Have you ever been overstayed your stay in the US
No
Yes
If yes: Provide details
Contact Person in the US
Contact person's address in the US
Contact Person's email address
Contact Person's phone number
Your father's name
Father's date of birth
date_range
Father's place of birth
Father's country of birth
Is your father in the US?
No
Yes
Your Mother's Name
Mother's date of birth
date_range
Mother's place of birth
Mother's country of birth
Is your mother in the US?
No
Yes
Name of Spouse if applicable
Spouse date of birth
date_range
Spouse place of birth
Spouse country of birth
Spouse address
Spouse telephone number
Spouse email address
What is your occupation
Employed
Self- employed
Retired
Student
Not Employed
If not employed, explain.
If employed what is your position
Monthly Income if employed
Present name of employer or business if self employed
Address of employer or business if self employed
Start Date
date_range
End date
Name of Supervisor
Employer Phone number
Employer email
Briefly explain your duties
Previous name of employer 2
Address of employer 2
Start Date
date_range
End Date
date_range
Monthly Income
Name of Supervisor
Supervisor Phone number
Supervisor email
Briefly explain your duties
Previous name of employer 3
Address of employer 3
Start Date
date_range
End Date
date_range
Name of Supervisor
Supervisor email
Supervisor Phone number
Briefly explain your duties
Monthly Income
Have you attended any educational institutions at a secondary level or above
No
Yes
Name of institution or school
*
Present Course of Study
Intended Course of Study in US
Start Date
date_range
End Date
date_range
Other Educational Institution
QUESTIONS FOR STUDENT OR J-1 APPLICANT ONLY
Course of Study in the US or Field for J-1
Preferred US State
Do you want to apply for a US student loan (For student only)
Yes
No
If yes do you have a co-signor for your student loan who is a US citizen/Green card holder?
Yes
No
Name of proposed co-signor
Your relationship with your proposed co-signor
QUESTIONS FOR STUDENT OR J-1 APPLICANT ONLY
Name Reference 1:
Address
Telephone number
Email address
Name Reference 2
Address
Telephone number
Email address
Name Reference 2
Address
Telephone number
Email address
Provide language you speak
Have you travelled to any other country
Yes
No
If yes, provide the countries you have visited
List of membership you belonged to, contributed to, or worked for any professional, social, or charitable organization
Attach biopage of passport
By clicking submit you hereby consent for us to file your application online (DS-160, application forms)
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