ESTA-ansökan
1
Applicant Information
2
Travel Information
3
Payment Information
DO NOT USE SPECIAL CHARACTERS WHEN FILLING OUT THIS APPLICATION. Ü should be UE. Ö should be OE. ß should be SS. Ä should be AE.
APPLICANT / PASSPORT INFORMATION
Enter all information in the same format as on your passport.
Family Name
*
First Name
*
Gender
*
Male
Female
Are you known by any other names or aliases?
*
Yes
No
Name or Alias
Family Name
*
First Name
*
Date of Birth
Day
*
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
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21
22
23
24
25
26
27
28
29
30
31
Month
*
Month
January
February
March
April
May
June
July
August
September
October
November
December
Year
*
Year
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
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1918
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1920
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1927
1928
1929
1930
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1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
City of Birth
*
Country of Birth
*
Country of Birth
AFGHANISTAN (AFG)
ALAND ISLANDS (ALA)
ALBANIA (ALB)
ALGERIA (DZA)
AMERICAN SAMOA (ASM)
ANDORRA (AND)
ANGOLA (AGO)
ANGUILLA (AIA)
ANTARCTICA (ATA)
ANTIGUA AND BARBUDA (ATG)
ARGENTINA (ARG)
ARMENIA (ARM)
ARUBA (ABW)
AUSTRALIA (AUS)
AUSTRIA (AUT)
AZERBAIJAN (AZE)
BAHAMAS (BHS)
BAHRAIN (BHR)
BANGLADESH (BGD)
BARBADOS (BRB)
BELARUS (BLR)
BELGIUM (BEL)
BELIZE (BLZ)
BENIN (BEN)
BERMUDA (BMU)
BHUTAN (BTN)
BOLIVIA (BOL)
BONAIRE, SINT EUSTATIUS AND SABA (BES)
BOSNIA AND HERZEGOVINA (BIH)
BOTSWANA (BWA)
BOUVET ISLAND (BVT)
BRAZIL (BRA)
BRITISH INDIAN OCEAN TERRITORY (IOT)
BRUNEI (BRN)
BULGARIA (BGR)
BURKINA FASO (BFA)
BURMA (BUR)
BURUNDI (BDI)
CAMBODIA (KHM)
CAMEROON (CMR)
CANADA (CAN)
CANTON AND ENDERBURY ISLANDS (CTE)
CAPE VERDE (CPV)
CAYMAN ISLANDS (GYM)
CENTRAL AFRICAN REPUBLIC (CAF)
CHAD (TCD)
CHILE (CHL)
CHINA (CHN)
CHRISTMAS ISLAND (CXR)
COCOS (KEELING) ISLANDS (CCK)
COLOMBIA (COL)
COMOROS (COM)
CONGO, DEMOCRATIC REPUBLIC OF (COD)
CONGO, REPUBLIC OF (COG)
COOK ISLANDS (COK)
COSTA RICA (CRI)
COTE D'IVOIRE (CIV)
CROATIA (HRV)
CUBA (CUB)
CURACAO (CUW)
CYPRUS (CYP)
CZECH REPUBLIC (CZE)
DEMOCRATIC YEMEN (YMD)
DENMARK (DNK)
DJIBOUTI (DJI)
DOMINICA (DMA)
DOMINICAN REPUBLIC (DOM)
DRONNING MAUD LAND (DML)
EAST TIMOR (TMP)
ECUADOR (ECU)
EGYPT (EGY)
EL SALVADOR (SLY)
EQUATORIAL GUINEA (GNQ)
ERITREA (ERI)
ESTONIA (EST)
EHIOPIA (ETH)
FALKLAND ISLANDS (FLK)
FARCE ISLANDS (FRO)
FIJI (FJI)
FINLAND (FIN)
FRANCE (FRA)
FRANCE METROPOLITAN (FXX)
FRENCH GUIANA (GUF)
FRENCH POLYNESIA (PYF)
FRENCH SOUTHERN TERRITORIES (ATF)
GABON (GAB)
GAMBIA (GMB)
GEORGIA (GEO)
GERMANY (DEU)
GHANA (GHA)
GIBRALTAR (GIB)
GREECE (GRC)
GREENLAND (GRL)
GRENADA (GRD)
GUADELOUPE (GLP)
GUAM (GUM)
GUATEMALA (GTM)
GUERNSEY (GGY)
GUINEA (GIN)
GUINEA-BISSAU (GNB)
GUYANA (GUY)
HAITI (HTI)
HEARD AND MC DONALD ISLANDS (HMO)
HONDURAS (HND)
HONG KONG (HKG)
HUNGARY (HUN)
ICELAND (ISL)
INDIA (IND)
INDONESIA (ION)
IRAN (IRN)
IRAQ (IRQ)
IRELAND (IRL)
ISLE OF MAN (IMN)
ISRAEL (ISR)
ITALY (ITA)
JAMAICA (JAM)
JAPAN (JPN)
JERSEY (JEY)
JOHNSTON ISLAND (JTN)
JORDAN (JOR)
KAZAKHSTAN (KAZ)
KENYA (KEN)
KIRIBATI (KIR)
KOSOVO (KVV)
KUWAIT (KWT)
KYRGYZSTAN (KGZ)
LAOS (LAO)
LATVIA (LVA)
LEBANON (LBN)
LESOTHO (LSD)
LIBERIA (LBR)
LIBYA (LBY)
LIECHTENSTEIN (LIE)
LITHUANIA (LTU)
LUXEMBOURG (LUX)
MACAU (MAC)
MACEDONIA (MKD)
MADAGASCAR (MDG)
MALAWI (MWI)
MALAYSIA (MYS)
MALDIVES (MDV)
MALI (MLI)
MALTA (MLT)
MARSHALL ISLANDS (MHL)
MARTINIQUE (MTQ)
MAURITANIA (MRT)
MAURITIUS (MUS)
MAYOTTE (MYT)
MEXICO (MEX)
MICRONESIA - FEDERATED STATES OF (FSM)
MIDWAY ISLANDS (MID)
MOLDOVA (MDA)
MONACO (MCO)
MONGOLIA (MNG)
MONTENEGRO (MNE)
MONTSERRAT (MSR)
MOROCCO (MAR)
MOZAMBIQUE (MOZ)
MYANMAR (MMR)
NAMIBIA (NAM)
NAURU (NRU)
NEPAL (NPL)
NETHERLANDS (NLD)
NETHERLANDS ANTILLES (ANT)
NEUTRAL ZONE (NTZ)
NEW CALEDONIA (NCL)
NEW ZEALAND (NZL)
NICARAGUA (NIC)
NIGER (NER)
NIGERIA (NGA)
NIUE (NIU)
NORFOLK ISLAND (NFK)
NORTH KOREA (PRK)
NORTHERN MARIANA ISLANDS (MNP)
NORWAY (NOR)
OMAN (OMN)
PAKISTAN (PAK)
PALAU (PLW)
PALESTINIAN TERRITORIES (PSE)
PANAMA (PAN)
PAPUA NEW GUINEA (PNG)
PARAGUAY (PRY)
PERU (PER)
PHILIPPINES (PHL)
PITCAIRN ISLANDS (PCN)
POLAND (POL)
PORTUGAL (PRT)
PUERTO RICO (PRI)
QATAR (QAT)
REUNION (REU)
ROMANIA (ROM)
RUSSIA (RUS)
RWANDA (RWA)
SAINT BARTHELEMY (BLM)
SAINT KITTS AND NEVIS (KNA)
SAINT LUCIA (LCA)
SAINT MARTIN (FRENCH PART) (MAF)
SAINT VINCENT AND THE GRENADINES (VCT)
SAMOA (WSM)
SAN MARINO (SMR)
SAO TOME AND PRINCIPE (STP)
SAUDI ARABIA (SAU)
SENEGAL (SEN)
SERBIA (SRB)
SERBIA AND MONTENEGRO (SCG)
SEYCHELLES (SYC)
SIERRA LEONE (SLE)
SINGAPORE (SGP)
SINT MAARTEN (DUTCH PART) (SXM)
SLOVAKIA (SVK)
SLOVENIA (SVN)
SOLOMON ISLANDS (SLB)
SOMALIA (SOM)
SOUTH AFRICA (ZAF)
SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS (SGS)
SOUTH KOREA (KOR)
SOUTH SUDAN (SSD)
SPAIN (ESP)
SRI LANKA (LKA)
ST. HELENA (SHN)
ST. PIERRE AND MIQUELON (SPM)
SUDAN (SON)
SVALBARD AND JAN MAVEN ISLANDS (SJM)
SWAZILAND (SWZ)
SWEDEN (SWE)
SWITZERLAND (CHE)
SYRIA (SYR)
TAIWAN (TWN)
TAJIKISTAN (TJK)
TANZANIA (TZA)
THAILAND (THA)
TIMOR-LESTE (TLS)
TOGO (TGO)
TOKELAU (TKL)
TONGA (TON)
TRINIDAD AND TOBAGO (TTO)
TUNISIA (TUN)
TURKEY (TUR)
TURKMENISTAN (TKM)
TURKS AND CAICOS ISLANDS (TCA)
TUVALU (TUV)
UGANDA (UGA)
UKRAINE (UKR)
UNITED ARAB EMIRATES (ARE)
UNITED KINGDOM (GBR)
UNITED STATES (USA)
UNITED STATES MINOR OUTLYING ISLANDS (UMI)
URUGUAY (URY)
UZBEKISTAN (UZB)
VANUATU (VUT)
VATICAN CITY STATE (HOLY SEE) (VAT)
VENEZUELA (VEN)
VIETNAM (VNM)
VIRGIN ISLANDS (BRITISH) (VGB)
VIRGIN ISLANDS (U.S.) (VIR)
WAKE ISLAND (WAK)
WALLIS AND FUTUNA ISLANDS (WLF)
WESTERN SAHARA (ESH)
YEMEN (YEM)
ZAIRE (ZAR)
ZAMBIA (ZMB)
ZIMBABWE (ZWE)
Passport Number
*
Country of Citizenship
*
Country of Citizenship
ANDORRA (AND)
AUSTRALIA (AUS)
AUSTRIA (AUT)
BELGIUM (BEL)
BRUNEI (BRN)
CHILE (CHL)
CZECH REPUBLIC (CZE)
DENMARK (DNK)
ESTONIA (EST)
FINLAND (FIN)
FRANCE (FRA)
GERMANY (DEU)
GREECE (GRC)
HUNGARY (HUN)
ICELAND (ISL)
IRELAND (IRL)
ITALY (ITA)
JAPAN (JPN)
LATVIA (LVA)
LIECHTENSTEIN (LIE)
LITHUANIA (LTU)
LUXEMBOURG (LUX)
MALTA (MLT)
MONACO (MCO)
NETHERLANDS (NLD)
NEW ZEALAND (NZL)
NORWAY (NOR)
PORTUGAL (PRT)
SAN MARINO (SMR)
SINGAPORE (SGP)
SLOVAKIA (SVK)
SLOVENIA (SVN)
SOUTH KOREA (KOR)
SPAIN (ESP)
SWEDEN (SWE)
SWITZERLAND (CHE)
TAIWAN (TWN)
UK - BRITISH CITIZEN (GBR)
UK - BRITISH DTC (GBD)
UK - BRITISH NATIONAL (O) (GBN)
UK - BRITISH OVERSEAS (GBO)
UK - BRITISH SUBJECT (GBS)
UK - PROTECTED PERSON (GBP)
National Identification Number
*
Issuing Country
*
Country
ANDORRA (AND)
AUSTRALIA (AUS)
AUSTRIA (AUT)
BELGIUM (BEL)
BRUNEI (BRN)
CHILE (CHL)
CZECH REPUBLIC (CZE)
DENMARK (DNK)
ESTONIA (EST)
FINLAND (FIN)
FRANCE (FRA)
GERMANY (DEU)
GREECE (GRC)
HUNGARY (HUN)
ICELAND (ISL)
IRELAND (IRL)
ITALY (ITA)
JAPAN (JPN)
LATVIA (LVA)
LIECHTENSTEIN (LIE)
LITHUANIA (LTU)
LUXEMBOURG (LUX)
MALTA (MLT)
MONACO (MCO)
NETHERLANDS (NLD)
NEW ZEALAND (NZL)
NORWAY (NOR)
PORTUGAL (PRT)
SAN MARINO (SMR)
SINGAPORE (SGP)
SLOVAKIA (SVK)
SLOVENIA (SVN)
SOUTH KOREA (KOR)
SPAIN (ESP)
SWEDEN (SWE)
SWITZERLAND (CHE)
TAIWAN (TWN)
UK - BRITISH CITIZEN (GBR)
UK - BRITISH DTC (GBD)
UK - BRITISH NATIONAL (O) (GBN)
UK - BRITISH OVERSEAS (GBO)
UK - BRITISH SUBJECT (GBS)
UK - PROTECTED PERSON (GBP)
Personal Identification Number
*
Issuance Date
Day
*
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Month
*
Month
January
February
March
April
May
June
July
August
September
October
November
December
Year
*
Year
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
Expiration Date
Day
*
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Month
*
Month
January
February
March
April
May
June
July
August
September
October
November
December
Year
*
Year
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
Have you ever been issued a passport or national identity card for travel by any other country?
*
If you have never been issued any one of these documents by any other country answer "No" to this question. If you have been issued one of these documents from another country, but you do not remember the passport number or national identification card number and the year of expiration answer "UNKNOWN" in the passport number field and four zeros "0000" in the year of expiration field.
Yes
No
Issuing Country
*
Country
AFGHANISTAN (AFG)
ALAND ISLANDS (ALA)
ALBANIA (ALB)
ALGERIA (DZA)
AMERICAN SAMOA (ASM)
ANDORRA (AND)
ANGOLA (AGO)
ANGUILLA (AIA)
ANTARCTICA (ATA)
ANTIGUA AND BARBUDA (ATG)
ARGENTINA (ARG)
ARMENIA (ARM)
ARUBA (ABW)
AUSTRALIA (AUS)
AUSTRIA (AUT)
AZERBAIJAN (AZE)
BAHAMAS (BHS)
BAHRAIN (BHR)
BANGLADESH (BGD)
BARBADOS (BRB)
BELARUS (BLR)
BELGIUM (BEL)
BELIZE (BLZ)
BENIN (BEN)
BERMUDA (BMU)
BHUTAN (BTN)
BOLIVIA (BOL)
BONAIRE, SINT EUSTATIUS AND SABA (BES)
BOSNIA AND HERZEGOVINA (BIH)
BOTSWANA (BWA)
BOUVET ISLAND (BVT)
BRAZIL (BRA)
BRITISH INDIAN OCEAN TERRITORY (IOT)
BRUNEI (BRN)
BULGARIA (BGR)
BURKINA FASO (BFA)
BURMA (BUR)
BURUNDI (BDI)
CAMBODIA (KHM)
CAMEROON (CMR)
CANADA (CAN)
CANTON AND ENDERBURY ISLANDS (CTE)
CAPE VERDE (CPV)
CAYMAN ISLANDS (GYM)
CENTRAL AFRICAN REPUBLIC (CAF)
CHAD (TCD)
CHILE (CHL)
CHINA (CHN)
CHRISTMAS ISLAND (CXR)
COCOS (KEELING) ISLANDS (CCK)
COLOMBIA (COL)
COMOROS (COM)
CONGO, DEMOCRATIC REPUBLIC OF (COD)
CONGO, REPUBLIC OF (COG)
COOK ISLANDS (COK)
COSTA RICA (CRI)
COTE D'IVOIRE (CIV)
CROATIA (HRV)
CUBA (CUB)
CURACAO (CUW)
CYPRUS (CYP)
CZECH REPUBLIC (CZE)
DEMOCRATIC YEMEN (YMD)
DENMARK (DNK)
DJIBOUTI (DJI)
DOMINICA (DMA)
DOMINICAN REPUBLIC (DOM)
DRONNING MAUD LAND (DML)
EAST TIMOR (TMP)
ECUADOR (ECU)
EGYPT (EGY)
EL SALVADOR (SLY)
EQUATORIAL GUINEA (GNQ)
ERITREA (ERI)
ESTONIA (EST)
EHIOPIA (ETH)
FALKLAND ISLANDS (FLK)
FARCE ISLANDS (FRO)
FIJI (FJI)
FINLAND (FIN)
FRANCE (FRA)
FRANCE METROPOLITAN (FXX)
FRENCH GUIANA (GUF)
FRENCH POLYNESIA (PYF)
FRENCH SOUTHERN TERRITORIES (ATF)
GABON (GAB)
GAMBIA (GMB)
GEORGIA (GEO)
GERMANY (DEU)
GHANA (GHA)
GIBRALTAR (GIB)
GREECE (GRC)
GREENLAND (GRL)
GRENADA (GRD)
GUADELOUPE (GLP)
GUAM (GUM)
GUATEMALA (GTM)
GUERNSEY (GGY)
GUINEA (GIN)
GUINEA-BISSAU (GNB)
GUYANA (GUY)
HAITI (HTI)
HEARD AND MC DONALD ISLANDS (HMO)
HONDURAS (HND)
HONG KONG (HKG)
HUNGARY (HUN)
ICELAND (ISL)
INDIA (IND)
INDONESIA (ION)
IRAN (IRN)
IRAQ (IRQ)
IRELAND (IRL)
ISLE OF MAN (IMN)
ISRAEL (ISR)
ITALY (ITA)
JAMAICA (JAM)
JAPAN (JPN)
JERSEY (JEY)
JOHNSTON ISLAND (JTN)
JORDAN (JOR)
KAZAKHSTAN (KAZ)
KENYA (KEN)
KIRIBATI (KIR)
KOSOVO (KVV)
KUWAIT (KWT)
KYRGYZSTAN (KGZ)
LAOS (LAO)
LATVIA (LVA)
LEBANON (LBN)
LESOTHO (LSD)
LIBERIA (LBR)
LIBYA (LBY)
LIECHTENSTEIN (LIE)
LITHUANIA (LTU)
LUXEMBOURG (LUX)
MACAU (MAC)
MACEDONIA (MKD)
MADAGASCAR (MDG)
MALAWI (MWI)
MALAYSIA (MYS)
MALDIVES (MDV)
MALI (MLI)
MALTA (MLT)
MARSHALL ISLANDS (MHL)
MARTINIQUE (MTQ)
MAURITANIA (MRT)
MAURITIUS (MUS)
MAYOTTE (MYT)
MEXICO (MEX)
MICRONESIA - FEDERATED STATES OF (FSM)
MIDWAY ISLANDS (MID)
MOLDOVA (MDA)
MONACO (MCO)
MONGOLIA (MNG)
MONTENEGRO (MNE)
MONTSERRAT (MSR)
MOROCCO (MAR)
MOZAMBIQUE (MOZ)
MYANMAR (MMR)
NAMIBIA (NAM)
NAURU (NRU)
NEPAL (NPL)
NETHERLANDS (NLD)
NETHERLANDS ANTILLES (ANT)
NEUTRAL ZONE (NTZ)
NEW CALEDONIA (NCL)
NEW ZEALAND (NZL)
NICARAGUA (NIC)
NIGER (NER)
NIGERIA (NGA)
NIUE (NIU)
NORFOLK ISLAND (NFK)
NORTH KOREA (PRK)
NORTHERN MARIANA ISLANDS (MNP)
NORWAY (NOR)
OMAN (OMN)
PAKISTAN (PAK)
PALAU (PLW)
PALESTINIAN TERRITORIES (PSE)
PANAMA (PAN)
PAPUA NEW GUINEA (PNG)
PARAGUAY (PRY)
PERU (PER)
PHILIPPINES (PHL)
PITCAIRN ISLANDS (PCN)
POLAND (POL)
PORTUGAL (PRT)
PUERTO RICO (PRI)
QATAR (QAT)
REUNION (REU)
ROMANIA (ROM)
RUSSIA (RUS)
RWANDA (RWA)
SAINT BARTHELEMY (BLM)
SAINT KITTS AND NEVIS (KNA)
SAINT LUCIA (LCA)
SAINT MARTIN (FRENCH PART) (MAF)
SAINT VINCENT AND THE GRENADINES (VCT)
SAMOA (WSM)
SAN MARINO (SMR)
SAO TOME AND PRINCIPE (STP)
SAUDI ARABIA (SAU)
SENEGAL (SEN)
SERBIA (SRB)
SERBIA AND MONTENEGRO (SCG)
SEYCHELLES (SYC)
SIERRA LEONE (SLE)
SINGAPORE (SGP)
SINT MAARTEN (DUTCH PART) (SXM)
SLOVAKIA (SVK)
SLOVENIA (SVN)
SOLOMON ISLANDS (SLB)
SOMALIA (SOM)
SOUTH AFRICA (ZAF)
SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS (SGS)
SOUTH KOREA (KOR)
SOUTH SUDAN (SSD)
SPAIN (ESP)
SRI LANKA (LKA)
ST. HELENA (SHN)
ST. PIERRE AND MIQUELON (SPM)
SUDAN (SON)
SVALBARD AND JAN MAVEN ISLANDS (SJM)
SWAZILAND (SWZ)
SWEDEN (SWE)
SWITZERLAND (CHE)
SYRIA (SYR)
TAIWAN (TWN)
TAJIKISTAN (TJK)
TANZANIA (TZA)
THAILAND (THA)
TIMOR-LESTE (TLS)
TOGO (TGO)
TOKELAU (TKL)
TONGA (TON)
TRINIDAD AND TOBAGO (TTO)
TUNISIA (TUN)
TURKEY (TUR)
TURKMENISTAN (TKM)
TURKS AND CAICOS ISLANDS (TCA)
TUVALU (TUV)
UGANDA (UGA)
UKRAINE (UKR)
UNITED ARAB EMIRATES (ARE)
UNITED KINGDOM (GBR)
UNITED STATES (USA)
UNITED STATES MINOR OUTLYING ISLANDS (UMI)
URUGUAY (URY)
UZBEKISTAN (UZB)
VANUATU (VUT)
VATICAN CITY STATE (HOLY SEE) (VAT)
VENEZUELA (VEN)
VIETNAM (VNM)
VIRGIN ISLANDS (BRITISH) (VGB)
VIRGIN ISLANDS (U.S.) (VIR)
WAKE ISLAND (WAK)
WALLIS AND FUTUNA ISLANDS (WLF)
WESTERN SAHARA (ESH)
YEMEN (YEM)
ZAIRE (ZAR)
ZAMBIA (ZMB)
ZIMBABWE (ZWE)
Document Type
*
Passport Number
National Identity Card Number
Document Number
*
Expiration Year
*
OTHER CITIZENSHIP/NATIONALITY
Are you now, a citizen or national of any other country?
*
Yes
No
Country of Citizenship / Nationality
*
Country
AFGHANISTAN (AFG)
ALAND ISLANDS (ALA)
ALBANIA (ALB)
ALGERIA (DZA)
AMERICAN SAMOA (ASM)
ANDORRA (AND)
ANGOLA (AGO)
ANGUILLA (AIA)
ANTARCTICA (ATA)
ANTIGUA AND BARBUDA (ATG)
ARGENTINA (ARG)
ARMENIA (ARM)
ARUBA (ABW)
AUSTRALIA (AUS)
AUSTRIA (AUT)
AZERBAIJAN (AZE)
BAHAMAS (BHS)
BAHRAIN (BHR)
BANGLADESH (BGD)
BARBADOS (BRB)
BELARUS (BLR)
BELGIUM (BEL)
BELIZE (BLZ)
BENIN (BEN)
BERMUDA (BMU)
BHUTAN (BTN)
BOLIVIA (BOL)
BONAIRE, SINT EUSTATIUS AND SABA (BES)
BOSNIA AND HERZEGOVINA (BIH)
BOTSWANA (BWA)
BOUVET ISLAND (BVT)
BRAZIL (BRA)
BRITISH INDIAN OCEAN TERRITORY (IOT)
BRUNEI (BRN)
BULGARIA (BGR)
BURKINA FASO (BFA)
BURMA (BUR)
BURUNDI (BDI)
CAMBODIA (KHM)
CAMEROON (CMR)
CANADA (CAN)
CANTON AND ENDERBURY ISLANDS (CTE)
CAPE VERDE (CPV)
CAYMAN ISLANDS (GYM)
CENTRAL AFRICAN REPUBLIC (CAF)
CHAD (TCD)
CHILE (CHL)
CHINA (CHN)
CHRISTMAS ISLAND (CXR)
COCOS (KEELING) ISLANDS (CCK)
COLOMBIA (COL)
COMOROS (COM)
CONGO, DEMOCRATIC REPUBLIC OF (COD)
CONGO, REPUBLIC OF (COG)
COOK ISLANDS (COK)
COSTA RICA (CRI)
COTE D'IVOIRE (CIV)
CROATIA (HRV)
CUBA (CUB)
CURACAO (CUW)
CYPRUS (CYP)
CZECH REPUBLIC (CZE)
DEMOCRATIC YEMEN (YMD)
DENMARK (DNK)
DJIBOUTI (DJI)
DOMINICA (DMA)
DOMINICAN REPUBLIC (DOM)
DRONNING MAUD LAND (DML)
EAST TIMOR (TMP)
ECUADOR (ECU)
EGYPT (EGY)
EL SALVADOR (SLY)
EQUATORIAL GUINEA (GNQ)
ERITREA (ERI)
ESTONIA (EST)
EHIOPIA (ETH)
FALKLAND ISLANDS (FLK)
FARCE ISLANDS (FRO)
FIJI (FJI)
FINLAND (FIN)
FRANCE (FRA)
FRANCE METROPOLITAN (FXX)
FRENCH GUIANA (GUF)
FRENCH POLYNESIA (PYF)
FRENCH SOUTHERN TERRITORIES (ATF)
GABON (GAB)
GAMBIA (GMB)
GEORGIA (GEO)
GERMANY (DEU)
GHANA (GHA)
GIBRALTAR (GIB)
GREECE (GRC)
GREENLAND (GRL)
GRENADA (GRD)
GUADELOUPE (GLP)
GUAM (GUM)
GUATEMALA (GTM)
GUERNSEY (GGY)
GUINEA (GIN)
GUINEA-BISSAU (GNB)
GUYANA (GUY)
HAITI (HTI)
HEARD AND MC DONALD ISLANDS (HMO)
HONDURAS (HND)
HONG KONG (HKG)
HUNGARY (HUN)
ICELAND (ISL)
INDIA (IND)
INDONESIA (ION)
IRAN (IRN)
IRAQ (IRQ)
IRELAND (IRL)
ISLE OF MAN (IMN)
ISRAEL (ISR)
ITALY (ITA)
JAMAICA (JAM)
JAPAN (JPN)
JERSEY (JEY)
JOHNSTON ISLAND (JTN)
JORDAN (JOR)
KAZAKHSTAN (KAZ)
KENYA (KEN)
KIRIBATI (KIR)
KOSOVO (KVV)
KUWAIT (KWT)
KYRGYZSTAN (KGZ)
LAOS (LAO)
LATVIA (LVA)
LEBANON (LBN)
LESOTHO (LSD)
LIBERIA (LBR)
LIBYA (LBY)
LIECHTENSTEIN (LIE)
LITHUANIA (LTU)
LUXEMBOURG (LUX)
MACAU (MAC)
MACEDONIA (MKD)
MADAGASCAR (MDG)
MALAWI (MWI)
MALAYSIA (MYS)
MALDIVES (MDV)
MALI (MLI)
MALTA (MLT)
MARSHALL ISLANDS (MHL)
MARTINIQUE (MTQ)
MAURITANIA (MRT)
MAURITIUS (MUS)
MAYOTTE (MYT)
MEXICO (MEX)
MICRONESIA - FEDERATED STATES OF (FSM)
MIDWAY ISLANDS (MID)
MOLDOVA (MDA)
MONACO (MCO)
MONGOLIA (MNG)
MONTENEGRO (MNE)
MONTSERRAT (MSR)
MOROCCO (MAR)
MOZAMBIQUE (MOZ)
MYANMAR (MMR)
NAMIBIA (NAM)
NAURU (NRU)
NEPAL (NPL)
NETHERLANDS (NLD)
NETHERLANDS ANTILLES (ANT)
NEUTRAL ZONE (NTZ)
NEW CALEDONIA (NCL)
NEW ZEALAND (NZL)
NICARAGUA (NIC)
NIGER (NER)
NIGERIA (NGA)
NIUE (NIU)
NORFOLK ISLAND (NFK)
NORTH KOREA (PRK)
NORTHERN MARIANA ISLANDS (MNP)
NORWAY (NOR)
OMAN (OMN)
PAKISTAN (PAK)
PALAU (PLW)
PALESTINIAN TERRITORIES (PSE)
PANAMA (PAN)
PAPUA NEW GUINEA (PNG)
PARAGUAY (PRY)
PERU (PER)
PHILIPPINES (PHL)
PITCAIRN ISLANDS (PCN)
POLAND (POL)
PORTUGAL (PRT)
PUERTO RICO (PRI)
QATAR (QAT)
REUNION (REU)
ROMANIA (ROM)
RUSSIA (RUS)
RWANDA (RWA)
SAINT BARTHELEMY (BLM)
SAINT KITTS AND NEVIS (KNA)
SAINT LUCIA (LCA)
SAINT MARTIN (FRENCH PART) (MAF)
SAINT VINCENT AND THE GRENADINES (VCT)
SAMOA (WSM)
SAN MARINO (SMR)
SAO TOME AND PRINCIPE (STP)
SAUDI ARABIA (SAU)
SENEGAL (SEN)
SERBIA (SRB)
SERBIA AND MONTENEGRO (SCG)
SEYCHELLES (SYC)
SIERRA LEONE (SLE)
SINGAPORE (SGP)
SINT MAARTEN (DUTCH PART) (SXM)
SLOVAKIA (SVK)
SLOVENIA (SVN)
SOLOMON ISLANDS (SLB)
SOMALIA (SOM)
SOUTH AFRICA (ZAF)
SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS (SGS)
SOUTH KOREA (KOR)
SOUTH SUDAN (SSD)
SPAIN (ESP)
SRI LANKA (LKA)
ST. HELENA (SHN)
ST. PIERRE AND MIQUELON (SPM)
SUDAN (SON)
SVALBARD AND JAN MAVEN ISLANDS (SJM)
SWAZILAND (SWZ)
SWEDEN (SWE)
SWITZERLAND (CHE)
SYRIA (SYR)
TAIWAN (TWN)
TAJIKISTAN (TJK)
TANZANIA (TZA)
THAILAND (THA)
TIMOR-LESTE (TLS)
TOGO (TGO)
TOKELAU (TKL)
TONGA (TON)
TRINIDAD AND TOBAGO (TTO)
TUNISIA (TUN)
TURKEY (TUR)
TURKMENISTAN (TKM)
TURKS AND CAICOS ISLANDS (TCA)
TUVALU (TUV)
UGANDA (UGA)
UKRAINE (UKR)
UNITED ARAB EMIRATES (ARE)
UNITED KINGDOM (GBR)
UNITED STATES (USA)
UNITED STATES MINOR OUTLYING ISLANDS (UMI)
URUGUAY (URY)
UZBEKISTAN (UZB)
VANUATU (VUT)
VATICAN CITY STATE (HOLY SEE) (VAT)
VENEZUELA (VEN)
VIETNAM (VNM)
VIRGIN ISLANDS (BRITISH) (VGB)
VIRGIN ISLANDS (U.S.) (VIR)
WAKE ISLAND (WAK)
WALLIS AND FUTUNA ISLANDS (WLF)
WESTERN SAHARA (ESH)
YEMEN (YEM)
ZAIRE (ZAR)
ZAMBIA (ZMB)
ZIMBABWE (ZWE)
How did you acquire citizenship / nationality from this country?
*
By birth
Through parents
Naturalized
Other
Other
*
Have you ever been a citizen or national of any other country?
*
Yes
No
Country of Citizenship / Nationality
*
Country
AFGHANISTAN (AFG)
ALAND ISLANDS (ALA)
ALBANIA (ALB)
ALGERIA (DZA)
AMERICAN SAMOA (ASM)
ANDORRA (AND)
ANGOLA (AGO)
ANGUILLA (AIA)
ANTARCTICA (ATA)
ANTIGUA AND BARBUDA (ATG)
ARGENTINA (ARG)
ARMENIA (ARM)
ARUBA (ABW)
AUSTRALIA (AUS)
AUSTRIA (AUT)
AZERBAIJAN (AZE)
BAHAMAS (BHS)
BAHRAIN (BHR)
BANGLADESH (BGD)
BARBADOS (BRB)
BELARUS (BLR)
BELGIUM (BEL)
BELIZE (BLZ)
BENIN (BEN)
BERMUDA (BMU)
BHUTAN (BTN)
BOLIVIA (BOL)
BONAIRE, SINT EUSTATIUS AND SABA (BES)
BOSNIA AND HERZEGOVINA (BIH)
BOTSWANA (BWA)
BOUVET ISLAND (BVT)
BRAZIL (BRA)
BRITISH INDIAN OCEAN TERRITORY (IOT)
BRUNEI (BRN)
BULGARIA (BGR)
BURKINA FASO (BFA)
BURMA (BUR)
BURUNDI (BDI)
CAMBODIA (KHM)
CAMEROON (CMR)
CANADA (CAN)
CANTON AND ENDERBURY ISLANDS (CTE)
CAPE VERDE (CPV)
CAYMAN ISLANDS (GYM)
CENTRAL AFRICAN REPUBLIC (CAF)
CHAD (TCD)
CHILE (CHL)
CHINA (CHN)
CHRISTMAS ISLAND (CXR)
COCOS (KEELING) ISLANDS (CCK)
COLOMBIA (COL)
COMOROS (COM)
CONGO, DEMOCRATIC REPUBLIC OF (COD)
CONGO, REPUBLIC OF (COG)
COOK ISLANDS (COK)
COSTA RICA (CRI)
COTE D'IVOIRE (CIV)
CROATIA (HRV)
CUBA (CUB)
CURACAO (CUW)
CYPRUS (CYP)
CZECH REPUBLIC (CZE)
DEMOCRATIC YEMEN (YMD)
DENMARK (DNK)
DJIBOUTI (DJI)
DOMINICA (DMA)
DOMINICAN REPUBLIC (DOM)
DRONNING MAUD LAND (DML)
EAST TIMOR (TMP)
ECUADOR (ECU)
EGYPT (EGY)
EL SALVADOR (SLY)
EQUATORIAL GUINEA (GNQ)
ERITREA (ERI)
ESTONIA (EST)
EHIOPIA (ETH)
FALKLAND ISLANDS (FLK)
FARCE ISLANDS (FRO)
FIJI (FJI)
FINLAND (FIN)
FRANCE (FRA)
FRANCE METROPOLITAN (FXX)
FRENCH GUIANA (GUF)
FRENCH POLYNESIA (PYF)
FRENCH SOUTHERN TERRITORIES (ATF)
GABON (GAB)
GAMBIA (GMB)
GEORGIA (GEO)
GERMANY (DEU)
GHANA (GHA)
GIBRALTAR (GIB)
GREECE (GRC)
GREENLAND (GRL)
GRENADA (GRD)
GUADELOUPE (GLP)
GUAM (GUM)
GUATEMALA (GTM)
GUERNSEY (GGY)
GUINEA (GIN)
GUINEA-BISSAU (GNB)
GUYANA (GUY)
HAITI (HTI)
HEARD AND MC DONALD ISLANDS (HMO)
HONDURAS (HND)
HONG KONG (HKG)
HUNGARY (HUN)
ICELAND (ISL)
INDIA (IND)
INDONESIA (ION)
IRAN (IRN)
IRAQ (IRQ)
IRELAND (IRL)
ISLE OF MAN (IMN)
ISRAEL (ISR)
ITALY (ITA)
JAMAICA (JAM)
JAPAN (JPN)
JERSEY (JEY)
JOHNSTON ISLAND (JTN)
JORDAN (JOR)
KAZAKHSTAN (KAZ)
KENYA (KEN)
KIRIBATI (KIR)
KOSOVO (KVV)
KUWAIT (KWT)
KYRGYZSTAN (KGZ)
LAOS (LAO)
LATVIA (LVA)
LEBANON (LBN)
LESOTHO (LSD)
LIBERIA (LBR)
LIBYA (LBY)
LIECHTENSTEIN (LIE)
LITHUANIA (LTU)
LUXEMBOURG (LUX)
MACAU (MAC)
MACEDONIA (MKD)
MADAGASCAR (MDG)
MALAWI (MWI)
MALAYSIA (MYS)
MALDIVES (MDV)
MALI (MLI)
MALTA (MLT)
MARSHALL ISLANDS (MHL)
MARTINIQUE (MTQ)
MAURITANIA (MRT)
MAURITIUS (MUS)
MAYOTTE (MYT)
MEXICO (MEX)
MICRONESIA - FEDERATED STATES OF (FSM)
MIDWAY ISLANDS (MID)
MOLDOVA (MDA)
MONACO (MCO)
MONGOLIA (MNG)
MONTENEGRO (MNE)
MONTSERRAT (MSR)
MOROCCO (MAR)
MOZAMBIQUE (MOZ)
MYANMAR (MMR)
NAMIBIA (NAM)
NAURU (NRU)
NEPAL (NPL)
NETHERLANDS (NLD)
NETHERLANDS ANTILLES (ANT)
NEUTRAL ZONE (NTZ)
NEW CALEDONIA (NCL)
NEW ZEALAND (NZL)
NICARAGUA (NIC)
NIGER (NER)
NIGERIA (NGA)
NIUE (NIU)
NORFOLK ISLAND (NFK)
NORTH KOREA (PRK)
NORTHERN MARIANA ISLANDS (MNP)
NORWAY (NOR)
OMAN (OMN)
PAKISTAN (PAK)
PALAU (PLW)
PALESTINIAN TERRITORIES (PSE)
PANAMA (PAN)
PAPUA NEW GUINEA (PNG)
PARAGUAY (PRY)
PERU (PER)
PHILIPPINES (PHL)
PITCAIRN ISLANDS (PCN)
POLAND (POL)
PORTUGAL (PRT)
PUERTO RICO (PRI)
QATAR (QAT)
REUNION (REU)
ROMANIA (ROM)
RUSSIA (RUS)
RWANDA (RWA)
SAINT BARTHELEMY (BLM)
SAINT KITTS AND NEVIS (KNA)
SAINT LUCIA (LCA)
SAINT MARTIN (FRENCH PART) (MAF)
SAINT VINCENT AND THE GRENADINES (VCT)
SAMOA (WSM)
SAN MARINO (SMR)
SAO TOME AND PRINCIPE (STP)
SAUDI ARABIA (SAU)
SENEGAL (SEN)
SERBIA (SRB)
SERBIA AND MONTENEGRO (SCG)
SEYCHELLES (SYC)
SIERRA LEONE (SLE)
SINGAPORE (SGP)
SINT MAARTEN (DUTCH PART) (SXM)
SLOVAKIA (SVK)
SLOVENIA (SVN)
SOLOMON ISLANDS (SLB)
SOMALIA (SOM)
SOUTH AFRICA (ZAF)
SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS (SGS)
SOUTH KOREA (KOR)
SOUTH SUDAN (SSD)
SPAIN (ESP)
SRI LANKA (LKA)
ST. HELENA (SHN)
ST. PIERRE AND MIQUELON (SPM)
SUDAN (SON)
SVALBARD AND JAN MAVEN ISLANDS (SJM)
SWAZILAND (SWZ)
SWEDEN (SWE)
SWITZERLAND (CHE)
SYRIA (SYR)
TAIWAN (TWN)
TAJIKISTAN (TJK)
TANZANIA (TZA)
THAILAND (THA)
TIMOR-LESTE (TLS)
TOGO (TGO)
TOKELAU (TKL)
TONGA (TON)
TRINIDAD AND TOBAGO (TTO)
TUNISIA (TUN)
TURKEY (TUR)
TURKMENISTAN (TKM)
TURKS AND CAICOS ISLANDS (TCA)
TUVALU (TUV)
UGANDA (UGA)
UKRAINE (UKR)
UNITED ARAB EMIRATES (ARE)
UNITED KINGDOM (GBR)
UNITED STATES (USA)
UNITED STATES MINOR OUTLYING ISLANDS (UMI)
URUGUAY (URY)
UZBEKISTAN (UZB)
VANUATU (VUT)
VATICAN CITY STATE (HOLY SEE) (VAT)
VENEZUELA (VEN)
VIETNAM (VNM)
VIRGIN ISLANDS (BRITISH) (VGB)
VIRGIN ISLANDS (U.S.) (VIR)
WAKE ISLAND (WAK)
WALLIS AND FUTUNA ISLANDS (WLF)
WESTERN SAHARA (ESH)
YEMEN (YEM)
ZAIRE (ZAR)
ZAMBIA (ZMB)
ZIMBABWE (ZWE)
GE MEMBERSHIP
Are you a member of the CBP Global Entry Program?
*
Yes
No
PASSID / Membership Number
*
PARENTS
Enter the names of your parents. These are required to complete the application. If you do not know the name of one or both of your parents, enter UNKNOWN, for each parent. This field can include the names of your biological, adoptive, step-parent or guardian.
Family Name
*
First Name
*
Family Name
*
First Name
*
YOUR CONTACT INFORMATION
Address Line 1
*
Address Line 2
Apartment Number
City
*
State/Province/Region
*
Country
*
Country
AFGHANISTAN (AFG)
ALAND ISLANDS (ALA)
ALBANIA (ALB)
ALGERIA (DZA)
AMERICAN SAMOA (ASM)
ANDORRA (AND)
ANGOLA (AGO)
ANGUILLA (AIA)
ANTARCTICA (ATA)
ANTIGUA AND BARBUDA (ATG)
ARGENTINA (ARG)
ARMENIA (ARM)
ARUBA (ABW)
AUSTRALIA (AUS)
AUSTRIA (AUT)
AZERBAIJAN (AZE)
BAHAMAS (BHS)
BAHRAIN (BHR)
BANGLADESH (BGD)
BARBADOS (BRB)
BELARUS (BLR)
BELGIUM (BEL)
BELIZE (BLZ)
BENIN (BEN)
BERMUDA (BMU)
BHUTAN (BTN)
BOLIVIA (BOL)
BONAIRE, SINT EUSTATIUS AND SABA (BES)
BOSNIA AND HERZEGOVINA (BIH)
BOTSWANA (BWA)
BOUVET ISLAND (BVT)
BRAZIL (BRA)
BRITISH INDIAN OCEAN TERRITORY (IOT)
BRUNEI (BRN)
BULGARIA (BGR)
BURKINA FASO (BFA)
BURMA (BUR)
BURUNDI (BDI)
CAMBODIA (KHM)
CAMEROON (CMR)
CANADA (CAN)
CANTON AND ENDERBURY ISLANDS (CTE)
CAPE VERDE (CPV)
CAYMAN ISLANDS (GYM)
CENTRAL AFRICAN REPUBLIC (CAF)
CHAD (TCD)
CHILE (CHL)
CHINA (CHN)
CHRISTMAS ISLAND (CXR)
COCOS (KEELING) ISLANDS (CCK)
COLOMBIA (COL)
COMOROS (COM)
CONGO, DEMOCRATIC REPUBLIC OF (COD)
CONGO, REPUBLIC OF (COG)
COOK ISLANDS (COK)
COSTA RICA (CRI)
COTE D'IVOIRE (CIV)
CROATIA (HRV)
CUBA (CUB)
CURACAO (CUW)
CYPRUS (CYP)
CZECH REPUBLIC (CZE)
DEMOCRATIC YEMEN (YMD)
DENMARK (DNK)
DJIBOUTI (DJI)
DOMINICA (DMA)
DOMINICAN REPUBLIC (DOM)
DRONNING MAUD LAND (DML)
EAST TIMOR (TMP)
ECUADOR (ECU)
EGYPT (EGY)
EL SALVADOR (SLY)
EQUATORIAL GUINEA (GNQ)
ERITREA (ERI)
ESTONIA (EST)
EHIOPIA (ETH)
FALKLAND ISLANDS (FLK)
FARCE ISLANDS (FRO)
FIJI (FJI)
FINLAND (FIN)
FRANCE (FRA)
FRANCE METROPOLITAN (FXX)
FRENCH GUIANA (GUF)
FRENCH POLYNESIA (PYF)
FRENCH SOUTHERN TERRITORIES (ATF)
GABON (GAB)
GAMBIA (GMB)
GEORGIA (GEO)
GERMANY (DEU)
GHANA (GHA)
GIBRALTAR (GIB)
GREECE (GRC)
GREENLAND (GRL)
GRENADA (GRD)
GUADELOUPE (GLP)
GUAM (GUM)
GUATEMALA (GTM)
GUERNSEY (GGY)
GUINEA (GIN)
GUINEA-BISSAU (GNB)
GUYANA (GUY)
HAITI (HTI)
HEARD AND MC DONALD ISLANDS (HMO)
HONDURAS (HND)
HONG KONG (HKG)
HUNGARY (HUN)
ICELAND (ISL)
INDIA (IND)
INDONESIA (ION)
IRAN (IRN)
IRAQ (IRQ)
IRELAND (IRL)
ISLE OF MAN (IMN)
ISRAEL (ISR)
ITALY (ITA)
JAMAICA (JAM)
JAPAN (JPN)
JERSEY (JEY)
JOHNSTON ISLAND (JTN)
JORDAN (JOR)
KAZAKHSTAN (KAZ)
KENYA (KEN)
KIRIBATI (KIR)
KOSOVO (KVV)
KUWAIT (KWT)
KYRGYZSTAN (KGZ)
LAOS (LAO)
LATVIA (LVA)
LEBANON (LBN)
LESOTHO (LSD)
LIBERIA (LBR)
LIBYA (LBY)
LIECHTENSTEIN (LIE)
LITHUANIA (LTU)
LUXEMBOURG (LUX)
MACAU (MAC)
MACEDONIA (MKD)
MADAGASCAR (MDG)
MALAWI (MWI)
MALAYSIA (MYS)
MALDIVES (MDV)
MALI (MLI)
MALTA (MLT)
MARSHALL ISLANDS (MHL)
MARTINIQUE (MTQ)
MAURITANIA (MRT)
MAURITIUS (MUS)
MAYOTTE (MYT)
MEXICO (MEX)
MICRONESIA - FEDERATED STATES OF (FSM)
MIDWAY ISLANDS (MID)
MOLDOVA (MDA)
MONACO (MCO)
MONGOLIA (MNG)
MONTENEGRO (MNE)
MONTSERRAT (MSR)
MOROCCO (MAR)
MOZAMBIQUE (MOZ)
MYANMAR (MMR)
NAMIBIA (NAM)
NAURU (NRU)
NEPAL (NPL)
NETHERLANDS (NLD)
NETHERLANDS ANTILLES (ANT)
NEUTRAL ZONE (NTZ)
NEW CALEDONIA (NCL)
NEW ZEALAND (NZL)
NICARAGUA (NIC)
NIGER (NER)
NIGERIA (NGA)
NIUE (NIU)
NORFOLK ISLAND (NFK)
NORTH KOREA (PRK)
NORTHERN MARIANA ISLANDS (MNP)
NORWAY (NOR)
OMAN (OMN)
PAKISTAN (PAK)
PALAU (PLW)
PALESTINIAN TERRITORIES (PSE)
PANAMA (PAN)
PAPUA NEW GUINEA (PNG)
PARAGUAY (PRY)
PERU (PER)
PHILIPPINES (PHL)
PITCAIRN ISLANDS (PCN)
POLAND (POL)
PORTUGAL (PRT)
PUERTO RICO (PRI)
QATAR (QAT)
REUNION (REU)
ROMANIA (ROM)
RUSSIA (RUS)
RWANDA (RWA)
SAINT BARTHELEMY (BLM)
SAINT KITTS AND NEVIS (KNA)
SAINT LUCIA (LCA)
SAINT MARTIN (FRENCH PART) (MAF)
SAINT VINCENT AND THE GRENADINES (VCT)
SAMOA (WSM)
SAN MARINO (SMR)
SAO TOME AND PRINCIPE (STP)
SAUDI ARABIA (SAU)
SENEGAL (SEN)
SERBIA (SRB)
SERBIA AND MONTENEGRO (SCG)
SEYCHELLES (SYC)
SIERRA LEONE (SLE)
SINGAPORE (SGP)
SINT MAARTEN (DUTCH PART) (SXM)
SLOVAKIA (SVK)
SLOVENIA (SVN)
SOLOMON ISLANDS (SLB)
SOMALIA (SOM)
SOUTH AFRICA (ZAF)
SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS (SGS)
SOUTH KOREA (KOR)
SOUTH SUDAN (SSD)
SPAIN (ESP)
SRI LANKA (LKA)
ST. HELENA (SHN)
ST. PIERRE AND MIQUELON (SPM)
SUDAN (SON)
SVALBARD AND JAN MAVEN ISLANDS (SJM)
SWAZILAND (SWZ)
SWEDEN (SWE)
SWITZERLAND (CHE)
SYRIA (SYR)
TAIWAN (TWN)
TAJIKISTAN (TJK)
TANZANIA (TZA)
THAILAND (THA)
TIMOR-LESTE (TLS)
TOGO (TGO)
TOKELAU (TKL)
TONGA (TON)
TRINIDAD AND TOBAGO (TTO)
TUNISIA (TUN)
TURKEY (TUR)
TURKMENISTAN (TKM)
TURKS AND CAICOS ISLANDS (TCA)
TUVALU (TUV)
UGANDA (UGA)
UKRAINE (UKR)
UNITED ARAB EMIRATES (ARE)
UNITED KINGDOM (GBR)
UNITED STATES (USA)
UNITED STATES MINOR OUTLYING ISLANDS (UMI)
URUGUAY (URY)
UZBEKISTAN (UZB)
VANUATU (VUT)
VATICAN CITY STATE (HOLY SEE) (VAT)
VENEZUELA (VEN)
VIETNAM (VNM)
VIRGIN ISLANDS (BRITISH) (VGB)
VIRGIN ISLANDS (U.S.) (VIR)
WAKE ISLAND (WAK)
WALLIS AND FUTUNA ISLANDS (WLF)
WESTERN SAHARA (ESH)
YEMEN (YEM)
ZAIRE (ZAR)
ZAMBIA (ZMB)
ZIMBABWE (ZWE)
Telephone Type
*
Telephone Type
Home
Work
Mobile
Other
Country Code
Country Code
AFGHANISTAN (AFG) (+93)
ALAND ISLANDS (ALA) (+358)
ALBANIA (ALB) (+355)
ALGERIA (DZA) (+213)
AMERICAN SAMOA (ASM) (+1)
ANDORRA (AND) (+376)
ANGOLA (AGO) (+244)
ANGUILLA (AIA) (+1)
ANTARCTICA (ATA) (+672)
ANTIGUA AND BARBUDA (ATG) (+1)
ARGENTINA (ARG) (+54)
ARMENIA (ARM) (+374)
ARUBA (ABW) (+297)
AUSTRALIA (AUS) (+61)
AUSTRIA (AUT) (+43)
AZERBAIJAN (AZE) (+994)
BAHAMAS (BHS) (+1)
BAHRAIN (BHR) (+973)
BANGLADESH (BGD) (+880)
BARBADOS (BRB) (+1)
BELARUS (BLR) (+375)
BELGIUM (BEL) (+32)
BELIZE (BLZ) (+501)
BENIN (BEN) (+229)
BERMUDA (BMU) (+1)
BHUTAN (BTN) (+975)
BOLIVIA (BOL) (+591)
BONAIRE, SINT EUSTATIUS AND SABA (BES) (+599)
BOSNIA AND HERZEGOVINA (BIH) (+387)
BOTSWANA (BWA) (+267)
BOUVET ISLAND (BVT) (+55)
BRAZIL (BRA) (+55)
BRITISH INDIAN OCEAN TERRITORY (IOT) (+246)
BRUNEI (BRN) (+673)
BULGARIA (BGR) (+359)
BURKINA FASO (BFA) (+226)
BURMA (BUR) (+95)
BURUNDI (BDI) (+257)
CAMBODIA (KHM) (+855)
CAMEROON (CMR) (+237)
CANADA (CAN) (+1)
CANTON AND ENDERBURY ISLANDS (CTE) (+686)
CAPE VERDE (CPV) (+238)
CAYMAN ISLANDS (CYM) (+1)
CENTRAL AFRICAN REPUBLIC (CAF) (+236)
CHAD (TCD) (+235)
CHILE (CHL) (+56)
CHINA (CHN) (+86)
CHRISTMAS ISLAND (CXR) (+61)
COCOS (KEELING) ISLANDS (CCK) (+61)
COLOMBIA (COL) (+57)
COMOROS (COM) (+269)
CONGO, DEMOCRATIC REPUBLIC OF (COD) (+243)
CONGO, REPUBLIC OF (COG) (+242)
COOK ISLANDS (COK) (+682)
COSTA RICA (CRI) (+506)
COTE D'IVOIRE (CIV) (+225)
CROATIA (HRV) (+385)
CUBA (CUB) (+53)
CURACAO (CUW) (+599)
CYPRUS (CYP) (+357)
CZECH REPUBLIC (CZE) (+420)
DEMOCRATIC YEMEN (YMD) (+967)
DENMARK (DNK) (+45)
DJIBOUTI (DJI) (+253)
DOMINICA (DMA) (+1)
DOMINICAN REPUBLIC (DOM) (+1)
EAST TIMOR (TMP) (+670)
ECUADOR (ECU) (+593)
EGYPT (EGY) (+20)
EL SALVADOR (SLV) (+503)
EQUATORIAL GUINEA (GNQ) (+240)
ERITREA (ERI) (+291)
ESTONIA (EST) (+372)
ETHIOPIA (ETH) (+251)
FALKLAND ISLANDS (FLK) (+500)
FAROE ISLANDS (FRO) (+298)
FIJI (FJI) (+679)
FINLAND (FIN) (+358)
FRANCE (FRA) (+33)
FRANCE METROPOLITAN (FXX) (+33)
FRENCH GUIANA (GUF) (+594)
FRENCH POLYNESIA (PYF) (+689)
FRENCH SOUTHERN TERRITORIES (ATF) (+262)
GABON (GAB) (+241)
GAMBIA (GMB) (+220)
GEORGIA (GEO) (+995)
GERMANY (DEU) (+49)
GHANA (GHA) (+233)
GIBRALTAR (GIB) (+350)
GREECE (GRC) (+30)
GREENLAND (GRL) (+299)
GRENADA (GRD) (+1)
GUADELOUPE (GLP) (+590)
GUAM (GUM) (+1)
GUATEMALA (GTM) (+502)
GUERNSEY (GGY) (+44)
GUINEA (GIN) (+224)
GUINEA-BISSAU (GNB) (+245)
GUYANA (GUY) (+592)
HAITI (HTI) (+509)
HEARD AND MC DONALD ISLANDS (HMD) (+0)
HONDURAS (HND) (+504)
HONG KONG (HKG) (+852)
HUNGARY (HUN) (+36)
ICELAND (ISL) (+354)
INDIA (IND) (+91)
INDONESIA (IDN) (+62)
IRAN (IRN) (+98)
IRAQ (IRQ) (+964)
IRELAND (IRL) (+353)
ISLE OF MAN (IMN) (+44)
ISRAEL (ISR) (+972)
ITALY (ITA) (+39)
JAMAICA (JAM) (+1)
JAPAN (JPN) (+81)
JERSEY (JEY) (+44)
JOHNSTON ISLAND (JTN) (+1)
JORDAN (JOR) (+962)
KAZAKHSTAN (KAZ) (+7)
KENYA (KEN) (+254)
KIRIBATI (KIR) (+686)
KOSOVO (KVV) (+383)
KUWAIT (KWT) (+965)
KYRGYZSTAN (KGZ) (+996)
LAOS (LAO) (+856)
LATVIA (LVA) (+371)
LEBANON (LBN) (+961)
LESOTHO (LSO) (+266)
LIBERIA (LBR) (+231)
LIBYA (LBY) (+218)
LIECHTENSTEIN (LIE) (+423)
LITHUANIA (LTU) (+370)
LUXEMBOURG (LUX) (+352)
MACAU (MAC) (+853)
MACEDONIA (MKD) (+389)
MADAGASCAR (MDG) (+261)
MALAWI (MWI) (+265)
MALAYSIA (MYS) (+60)
MALDIVES (MDV) (+960)
MALI (MLI) (+223)
MALTA (MLT) (+356)
MARSHALL ISLANDS (MHL) (+692)
MARTINIQUE (MTQ) (+596)
MAURITANIA (MRT) (+222)
MAURITIUS (MUS) (+230)
MAYOTTE (MYT) (+262)
MEXICO (MEX) (+52)
MICRONESIA - FEDERATED STATES OF (FSM) (+691)
MIDWAY ISLANDS (MID) (+1)
MOLDOVA (MDA) (+373)
MONACO (MCO) (+377)
MONGOLIA (MNG) (+976)
MONTENEGRO (MNE) (+382)
MONTSERRAT (MSR) (+1)
MOROCCO (MAR) (+212)
MOZAMBIQUE (MOZ) (+258)
MYANMAR (MMR) (+95)
NAMIBIA (NAM) (+264)
NAURU (NRU) (+674)
NEPAL (NPL) (+977)
NETHERLANDS (NLD) (+31)
NETHERLANDS ANTILLES (ANT) (+599)
NEW CALEDONIA (NCL) (+687)
NEW ZEALAND (NZL) (+64)
NICARAGUA (NIC) (+505)
NIGER (NER) (+227)
NIGERIA (NGA) (+234)
NIUE (NIU) (+683)
NORFOLK ISLAND (NFK) (+672)
NORTH KOREA (PRK) (+850)
NORTHERN MARIANA ISLANDS (MNP) (+1)
NORWAY (NOR) (+47)
OMAN (OMN) (+968)
PAKISTAN (PAK) (+92)
PALAU (PLW) (+680)
PALESTINIAN TERRITORIES (PSE) (+970)
PANAMA (PAN) (+507)
PAPUA NEW GUINEA (PNG) (+675)
PARAGUAY (PRY) (+595)
PERU (PER) (+51)
PHILIPPINES (PHL) (+63)
PITCAIRN ISLANDS (PCN) (+64)
POLAND (POL) (+48)
PORTUGAL (PRT) (+351)
PUERTO RICO (PRI) (+1)
QATAR (QAT) (+974)
REUNION (REU) (+262)
ROMANIA (ROM) (+40)
RUSSIA (RUS) (+7)
RWANDA (RWA) (+250)
SAINT BARTHELEMY (BLM) (+590)
SAINT KITTS AND NEVIS (KNA) (+1)
SAINT LUCIA (LCA) (+1)
SAINT MARTIN (FRENCH PART) (MAF) (+590)
SAINT VINCENT AND THE GRENADINES (VCT) (+1)
SAMOA (WSM) (+685)
SAN MARINO (SMR) (+378)
SAO TOME AND PRINCIPE (STP) (+239)
SAUDI ARABIA (SAU) (+966)
SENEGAL (SEN) (+221)
SERBIA (SRB) (+381)
SERBIA AND MONTENEGRO (SCG) (+381)
SEYCHELLES (SYC) (+248)
SIERRA LEONE (SLE) (+232)
SINGAPORE (SGP) (+65)
SINT MAARTEN (DUTCH PART) (SXM) (+1)
SLOVAKIA (SVK) (+421)
SLOVENIA (SVN) (+386)
SOLOMON ISLANDS (SLB) (+677)
SOMALIA (SOM) (+252)
SOUTH AFRICA (ZAF) (+27)
SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS (SGS) (+500)
SOUTH KOREA (KOR) (+82)
SOUTH SUDAN (SSD) (+211)
SPAIN (ESP) (+34)
SRI LANKA (LKA) (+94)
ST. HELENA (SHN) (+290)
ST. PIERRE AND MIQUELON (SPM) (+508)
SUDAN (SDN) (+249)
SURINAME (SUR) (+597)
SVALBARD AND JAN MAYEN ISLANDS (SJM) (+47)
SWAZILAND (SWZ) (+268)
SWEDEN (SWE) (+46)
SWITZERLAND (CHE) (+41)
SYRIA (SYR) (+963)
TAIWAN (TWN) (+886)
TAJIKISTAN (TJK) (+992)
TANZANIA (TZA) (+255)
THAILAND (THA) (+66)
TIMOR-LESTE (TLS) (+670)
TOGO (TGO) (+228)
TOKELAU (TKL) (+690)
TONGA (TON) (+676)
TRINIDAD AND TOBAGO (TTO) (+1)
TUNISIA (TUN) (+216)
TURKEY (TUR) (+90)
TURKMENISTAN (TKM) (+993)
TURKS AND CAICOS ISLANDS (TCA) (+1)
TUVALU (TUV) (+688)
UGANDA (UGA) (+256)
UKRAINE (UKR) (+380)
UNITED ARAB EMIRATES (ARE) (+971)
UNITED KINGDOM (GBR) (+44)
UNITED STATES (USA) (+1)
UNITED STATES MINOR OUTLYING ISLANDS (UMI) (+1)
URUGUAY (URY) (+598)
UZBEKISTAN (UZB) (+998)
VANUATU (VUT) (+678)
VATICAN CITY STATE (HOLY SEE) (VAT) (+379)
VENEZUELA (VEN) (+58)
VIETNAM (VNM) (+84)
VIRGIN ISLANDS (BRITISH) (VGB) (+1)
VIRGIN ISLANDS (U.S.) (VIR) (+1)
WAKE ISLAND (WAK) (+808)
WALLIS AND FUTUNA ISLANDS (WLF) (+681)
WESTERN SAHARA (ESH) (+212)
YEMEN (YEM) (+967)
ZAIRE (ZAR) (+243)
ZAMBIA (ZMB) (+260)
ZIMBABWE (ZWE) (+263)
Phone
*
E-mail Address
*
SOCIAL MEDIA (OPTIONAL)
Please enter information associated with your online presence.
Provider / Platform
Provider / Platform
ASKfm
Facebook
Flickr
GitHub
Google+
Instagram
JustPaste.it
LinkedIn
Tumblr
Twitter
Vine
VKontakte (VK)
YouTube
Other
Other Platform / Provider
*
Social Media Identifier
*
List the username, handle, screen-name, or other identifier associated with your social media profile.
EMPLOYMENT INFORMATION
Do you have a current or previous employer?
*
Yes
No
Employer Name
*
Address Line 1
*
Address Line 2
City
*
State/Province/Region
*
Country
*
Country
AFGHANISTAN (AFG)
ALAND ISLANDS (ALA)
ALBANIA (ALB)
ALGERIA (DZA)
AMERICAN SAMOA (ASM)
ANDORRA (AND)
ANGOLA (AGO)
ANGUILLA (AIA)
ANTARCTICA (ATA)
ANTIGUA AND BARBUDA (ATG)
ARGENTINA (ARG)
ARMENIA (ARM)
ARUBA (ABW)
AUSTRALIA (AUS)
AUSTRIA (AUT)
AZERBAIJAN (AZE)
BAHAMAS (BHS)
BAHRAIN (BHR)
BANGLADESH (BGD)
BARBADOS (BRB)
BELARUS (BLR)
BELGIUM (BEL)
BELIZE (BLZ)
BENIN (BEN)
BERMUDA (BMU)
BHUTAN (BTN)
BOLIVIA (BOL)
BONAIRE, SINT EUSTATIUS AND SABA (BES)
BOSNIA AND HERZEGOVINA (BIH)
BOTSWANA (BWA)
BOUVET ISLAND (BVT)
BRAZIL (BRA)
BRITISH INDIAN OCEAN TERRITORY (IOT)
BRUNEI (BRN)
BULGARIA (BGR)
BURKINA FASO (BFA)
BURMA (BUR)
BURUNDI (BDI)
CAMBODIA (KHM)
CAMEROON (CMR)
CANADA (CAN)
CANTON AND ENDERBURY ISLANDS (CTE)
CAPE VERDE (CPV)
CAYMAN ISLANDS (GYM)
CENTRAL AFRICAN REPUBLIC (CAF)
CHAD (TCD)
CHILE (CHL)
CHINA (CHN)
CHRISTMAS ISLAND (CXR)
COCOS (KEELING) ISLANDS (CCK)
COLOMBIA (COL)
COMOROS (COM)
CONGO, DEMOCRATIC REPUBLIC OF (COD)
CONGO, REPUBLIC OF (COG)
COOK ISLANDS (COK)
COSTA RICA (CRI)
COTE D'IVOIRE (CIV)
CROATIA (HRV)
CUBA (CUB)
CURACAO (CUW)
CYPRUS (CYP)
CZECH REPUBLIC (CZE)
DEMOCRATIC YEMEN (YMD)
DENMARK (DNK)
DJIBOUTI (DJI)
DOMINICA (DMA)
DOMINICAN REPUBLIC (DOM)
DRONNING MAUD LAND (DML)
EAST TIMOR (TMP)
ECUADOR (ECU)
EGYPT (EGY)
EL SALVADOR (SLY)
EQUATORIAL GUINEA (GNQ)
ERITREA (ERI)
ESTONIA (EST)
EHIOPIA (ETH)
FALKLAND ISLANDS (FLK)
FARCE ISLANDS (FRO)
FIJI (FJI)
FINLAND (FIN)
FRANCE (FRA)
FRANCE METROPOLITAN (FXX)
FRENCH GUIANA (GUF)
FRENCH POLYNESIA (PYF)
FRENCH SOUTHERN TERRITORIES (ATF)
GABON (GAB)
GAMBIA (GMB)
GEORGIA (GEO)
GERMANY (DEU)
GHANA (GHA)
GIBRALTAR (GIB)
GREECE (GRC)
GREENLAND (GRL)
GRENADA (GRD)
GUADELOUPE (GLP)
GUAM (GUM)
GUATEMALA (GTM)
GUERNSEY (GGY)
GUINEA (GIN)
GUINEA-BISSAU (GNB)
GUYANA (GUY)
HAITI (HTI)
HEARD AND MC DONALD ISLANDS (HMO)
HONDURAS (HND)
HONG KONG (HKG)
HUNGARY (HUN)
ICELAND (ISL)
INDIA (IND)
INDONESIA (ION)
IRAN (IRN)
IRAQ (IRQ)
IRELAND (IRL)
ISLE OF MAN (IMN)
ISRAEL (ISR)
ITALY (ITA)
JAMAICA (JAM)
JAPAN (JPN)
JERSEY (JEY)
JOHNSTON ISLAND (JTN)
JORDAN (JOR)
KAZAKHSTAN (KAZ)
KENYA (KEN)
KIRIBATI (KIR)
KOSOVO (KVV)
KUWAIT (KWT)
KYRGYZSTAN (KGZ)
LAOS (LAO)
LATVIA (LVA)
LEBANON (LBN)
LESOTHO (LSD)
LIBERIA (LBR)
LIBYA (LBY)
LIECHTENSTEIN (LIE)
LITHUANIA (LTU)
LUXEMBOURG (LUX)
MACAU (MAC)
MACEDONIA (MKD)
MADAGASCAR (MDG)
MALAWI (MWI)
MALAYSIA (MYS)
MALDIVES (MDV)
MALI (MLI)
MALTA (MLT)
MARSHALL ISLANDS (MHL)
MARTINIQUE (MTQ)
MAURITANIA (MRT)
MAURITIUS (MUS)
MAYOTTE (MYT)
MEXICO (MEX)
MICRONESIA - FEDERATED STATES OF (FSM)
MIDWAY ISLANDS (MID)
MOLDOVA (MDA)
MONACO (MCO)
MONGOLIA (MNG)
MONTENEGRO (MNE)
MONTSERRAT (MSR)
MOROCCO (MAR)
MOZAMBIQUE (MOZ)
MYANMAR (MMR)
NAMIBIA (NAM)
NAURU (NRU)
NEPAL (NPL)
NETHERLANDS (NLD)
NETHERLANDS ANTILLES (ANT)
NEUTRAL ZONE (NTZ)
NEW CALEDONIA (NCL)
NEW ZEALAND (NZL)
NICARAGUA (NIC)
NIGER (NER)
NIGERIA (NGA)
NIUE (NIU)
NORFOLK ISLAND (NFK)
NORTH KOREA (PRK)
NORTHERN MARIANA ISLANDS (MNP)
NORWAY (NOR)
OMAN (OMN)
PAKISTAN (PAK)
PALAU (PLW)
PALESTINIAN TERRITORIES (PSE)
PANAMA (PAN)
PAPUA NEW GUINEA (PNG)
PARAGUAY (PRY)
PERU (PER)
PHILIPPINES (PHL)
PITCAIRN ISLANDS (PCN)
POLAND (POL)
PORTUGAL (PRT)
PUERTO RICO (PRI)
QATAR (QAT)
REUNION (REU)
ROMANIA (ROM)
RUSSIA (RUS)
RWANDA (RWA)
SAINT BARTHELEMY (BLM)
SAINT KITTS AND NEVIS (KNA)
SAINT LUCIA (LCA)
SAINT MARTIN (FRENCH PART) (MAF)
SAINT VINCENT AND THE GRENADINES (VCT)
SAMOA (WSM)
SAN MARINO (SMR)
SAO TOME AND PRINCIPE (STP)
SAUDI ARABIA (SAU)
SENEGAL (SEN)
SERBIA (SRB)
SERBIA AND MONTENEGRO (SCG)
SEYCHELLES (SYC)
SIERRA LEONE (SLE)
SINGAPORE (SGP)
SINT MAARTEN (DUTCH PART) (SXM)
SLOVAKIA (SVK)
SLOVENIA (SVN)
SOLOMON ISLANDS (SLB)
SOMALIA (SOM)
SOUTH AFRICA (ZAF)
SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS (SGS)
SOUTH KOREA (KOR)
SOUTH SUDAN (SSD)
SPAIN (ESP)
SRI LANKA (LKA)
ST. HELENA (SHN)
ST. PIERRE AND MIQUELON (SPM)
SUDAN (SON)
SVALBARD AND JAN MAVEN ISLANDS (SJM)
SWAZILAND (SWZ)
SWEDEN (SWE)
SWITZERLAND (CHE)
SYRIA (SYR)
TAIWAN (TWN)
TAJIKISTAN (TJK)
TANZANIA (TZA)
THAILAND (THA)
TIMOR-LESTE (TLS)
TOGO (TGO)
TOKELAU (TKL)
TONGA (TON)
TRINIDAD AND TOBAGO (TTO)
TUNISIA (TUN)
TURKEY (TUR)
TURKMENISTAN (TKM)
TURKS AND CAICOS ISLANDS (TCA)
TUVALU (TUV)
UGANDA (UGA)
UKRAINE (UKR)
UNITED ARAB EMIRATES (ARE)
UNITED KINGDOM (GBR)
UNITED STATES (USA)
UNITED STATES MINOR OUTLYING ISLANDS (UMI)
URUGUAY (URY)
UZBEKISTAN (UZB)
VANUATU (VUT)
VATICAN CITY STATE (HOLY SEE) (VAT)
VENEZUELA (VEN)
VIETNAM (VNM)
VIRGIN ISLANDS (BRITISH) (VGB)
VIRGIN ISLANDS (U.S.) (VIR)
WAKE ISLAND (WAK)
WALLIS AND FUTUNA ISLANDS (WLF)
WESTERN SAHARA (ESH)
YEMEN (YEM)
ZAIRE (ZAR)
ZAMBIA (ZMB)
ZIMBABWE (ZWE)
Is your travel to the US occurring in transit to another country?
*
Yes
No
U.S. POINT OF CONTACT INFORMATION
A U.S. point of contact may be a friend, relative, or business associate. If you do not have a U.S. point of contact, please enter the name, address and telephone number of the location where you will be staying (e.g. a hotel name). You mav also enter UNKNOWN.
Name
*
Address Line 1
*
Address Line 2
Apartment Number
City
*
State
*
You may also select UNKNOWN.
State
ALABAMA
ALASKA
AMERICAN SAMOA
ARIZONA
ARKANSAS
CALIFORNIA
COLORADO
CONNECTICUT
DELAWARE
DISTRICT OF COLUMBIA
FLORIDA
GEORGIA
GUAM
HAWAII
IDAHO
ILLINOIS
INDIANA
IOWA
KANSAS
KENTUCKY
LOUISIANA
MAINE
MARYLAND
MASSACHUSETTS
MICHIGAN
MINNESOTA
MISSISSIPPI
MISSOURI
MONTANA
NESRASKA
NEVADA
NEW HAMPSHIRE
NEW JERSEY
NEW MEXICO
NEW YORK
NORTH CAROLINA
NORTH DAKOTA
NORTH MARIANA ISL
OHIO
OKLAHOMA
OREGON
PENNSYLVANIA
PUERTO RICO
RHODE ISLAND
SOUTH CAROLINA
SOUTH DAKOTA
TENNESSEE
TEXAS
UTAH
VERMONT
VIRGIN ISLANDS
VIRGINIA
WASHINGTON
WEST VIRGINIA
WISCONSIN
WYOMING
UNKNOWN
Country code
*
AFGHANISTAN (AFG) (+93)
ALAND ISLANDS (ALA) (+358)
ALBANIA (ALB) (+355)
ALGERIA (DZA) (+213)
AMERICAN SAMOA (ASM) (+1)
ANDORRA (AND) (+376)
ANGOLA (AGO) (+244)
ANGUILLA (AIA) (+1)
ANTARCTICA (ATA) (+672)
ANTIGUA AND BARBUDA (ATG) (+1)
ARGENTINA (ARG) (+54)
ARMENIA (ARM) (+374)
ARUBA (ABW) (+297)
AUSTRALIA (AUS) (+61)
AUSTRIA (AUT) (+43)
AZERBAIJAN (AZE) (+994)
BAHAMAS (BHS) (+1)
BAHRAIN (BHR) (+973)
BANGLADESH (BGD) (+880)
BARBADOS (BRB) (+1)
BELARUS (BLR) (+375)
BELGIUM (BEL) (+32)
BELIZE (BLZ) (+501)
BENIN (BEN) (+229)
BERMUDA (BMU) (+1)
BHUTAN (BTN) (+975)
BOLIVIA (BOL) (+591)
BONAIRE, SINT EUSTATIUS AND SABA (BES) (+599)
BOSNIA AND HERZEGOVINA (BIH) (+387)
BOTSWANA (BWA) (+267)
BOUVET ISLAND (BVT) (+55)
BRAZIL (BRA) (+55)
BRITISH INDIAN OCEAN TERRITORY (IOT) (+246)
BRUNEI (BRN) (+673)
BULGARIA (BGR) (+359)
BURKINA FASO (BFA) (+226)
BURMA (BUR) (+95)
BURUNDI (BDI) (+257)
CAMBODIA (KHM) (+855)
CAMEROON (CMR) (+237)
CANADA (CAN) (+1)
CANTON AND ENDERBURY ISLANDS (CTE) (+686)
CAPE VERDE (CPV) (+238)
CAYMAN ISLANDS (CYM) (+1)
CENTRAL AFRICAN REPUBLIC (CAF) (+236)
CHAD (TCD) (+235)
CHILE (CHL) (+56)
CHINA (CHN) (+86)
CHRISTMAS ISLAND (CXR) (+61)
COCOS (KEELING) ISLANDS (CCK) (+61)
COLOMBIA (COL) (+57)
COMOROS (COM) (+269)
CONGO, DEMOCRATIC REPUBLIC OF (COD) (+243)
CONGO, REPUBLIC OF (COG) (+242)
COOK ISLANDS (COK) (+682)
COSTA RICA (CRI) (+506)
COTE D'IVOIRE (CIV) (+225)
CROATIA (HRV) (+385)
CUBA (CUB) (+53)
CURACAO (CUW) (+599)
CYPRUS (CYP) (+357)
CZECH REPUBLIC (CZE) (+420)
DEMOCRATIC YEMEN (YMD) (+967)
DENMARK (DNK) (+45)
DJIBOUTI (DJI) (+253)
DOMINICA (DMA) (+1)
DOMINICAN REPUBLIC (DOM) (+1)
EAST TIMOR (TMP) (+670)
ECUADOR (ECU) (+593)
EGYPT (EGY) (+20)
EL SALVADOR (SLV) (+503)
EQUATORIAL GUINEA (GNQ) (+240)
ERITREA (ERI) (+291)
ESTONIA (EST) (+372)
ETHIOPIA (ETH) (+251)
FALKLAND ISLANDS (FLK) (+500)
FAROE ISLANDS (FRO) (+298)
FIJI (FJI) (+679)
FINLAND (FIN) (+358)
FRANCE (FRA) (+33)
FRANCE METROPOLITAN (FXX) (+33)
FRENCH GUIANA (GUF) (+594)
FRENCH POLYNESIA (PYF) (+689)
FRENCH SOUTHERN TERRITORIES (ATF) (+262)
GABON (GAB) (+241)
GAMBIA (GMB) (+220)
GEORGIA (GEO) (+995)
GERMANY (DEU) (+49)
GHANA (GHA) (+233)
GIBRALTAR (GIB) (+350)
GREECE (GRC) (+30)
GREENLAND (GRL) (+299)
GRENADA (GRD) (+1)
GUADELOUPE (GLP) (+590)
GUAM (GUM) (+1)
GUATEMALA (GTM) (+502)
GUERNSEY (GGY) (+44)
GUINEA (GIN) (+224)
GUINEA-BISSAU (GNB) (+245)
GUYANA (GUY) (+592)
HAITI (HTI) (+509)
HEARD AND MC DONALD ISLANDS (HMD) (+0)
HONDURAS (HND) (+504)
HONG KONG (HKG) (+852)
HUNGARY (HUN) (+36)
ICELAND (ISL) (+354)
INDIA (IND) (+91)
INDONESIA (IDN) (+62)
IRAN (IRN) (+98)
IRAQ (IRQ) (+964)
IRELAND (IRL) (+353)
ISLE OF MAN (IMN) (+44)
ISRAEL (ISR) (+972)
ITALY (ITA) (+39)
JAMAICA (JAM) (+1)
JAPAN (JPN) (+81)
JERSEY (JEY) (+44)
JOHNSTON ISLAND (JTN) (+1)
JORDAN (JOR) (+962)
KAZAKHSTAN (KAZ) (+7)
KENYA (KEN) (+254)
KIRIBATI (KIR) (+686)
KOSOVO (KVV) (+383)
KUWAIT (KWT) (+965)
KYRGYZSTAN (KGZ) (+996)
LAOS (LAO) (+856)
LATVIA (LVA) (+371)
LEBANON (LBN) (+961)
LESOTHO (LSO) (+266)
LIBERIA (LBR) (+231)
LIBYA (LBY) (+218)
LIECHTENSTEIN (LIE) (+423)
LITHUANIA (LTU) (+370)
LUXEMBOURG (LUX) (+352)
MACAU (MAC) (+853)
MACEDONIA (MKD) (+389)
MADAGASCAR (MDG) (+261)
MALAWI (MWI) (+265)
MALAYSIA (MYS) (+60)
MALDIVES (MDV) (+960)
MALI (MLI) (+223)
MALTA (MLT) (+356)
MARSHALL ISLANDS (MHL) (+692)
MARTINIQUE (MTQ) (+596)
MAURITANIA (MRT) (+222)
MAURITIUS (MUS) (+230)
MAYOTTE (MYT) (+262)
MEXICO (MEX) (+52)
MICRONESIA - FEDERATED STATES OF (FSM) (+691)
MIDWAY ISLANDS (MID) (+1)
MOLDOVA (MDA) (+373)
MONACO (MCO) (+377)
MONGOLIA (MNG) (+976)
MONTENEGRO (MNE) (+382)
MONTSERRAT (MSR) (+1)
MOROCCO (MAR) (+212)
MOZAMBIQUE (MOZ) (+258)
MYANMAR (MMR) (+95)
NAMIBIA (NAM) (+264)
NAURU (NRU) (+674)
NEPAL (NPL) (+977)
NETHERLANDS (NLD) (+31)
NETHERLANDS ANTILLES (ANT) (+599)
NEW CALEDONIA (NCL) (+687)
NEW ZEALAND (NZL) (+64)
NICARAGUA (NIC) (+505)
NIGER (NER) (+227)
NIGERIA (NGA) (+234)
NIUE (NIU) (+683)
NORFOLK ISLAND (NFK) (+672)
NORTH KOREA (PRK) (+850)
NORTHERN MARIANA ISLANDS (MNP) (+1)
NORWAY (NOR) (+47)
OMAN (OMN) (+968)
PAKISTAN (PAK) (+92)
PALAU (PLW) (+680)
PALESTINIAN TERRITORIES (PSE) (+970)
PANAMA (PAN) (+507)
PAPUA NEW GUINEA (PNG) (+675)
PARAGUAY (PRY) (+595)
PERU (PER) (+51)
PHILIPPINES (PHL) (+63)
PITCAIRN ISLANDS (PCN) (+64)
POLAND (POL) (+48)
PORTUGAL (PRT) (+351)
PUERTO RICO (PRI) (+1)
QATAR (QAT) (+974)
REUNION (REU) (+262)
ROMANIA (ROM) (+40)
RUSSIA (RUS) (+7)
RWANDA (RWA) (+250)
SAINT BARTHELEMY (BLM) (+590)
SAINT KITTS AND NEVIS (KNA) (+1)
SAINT LUCIA (LCA) (+1)
SAINT MARTIN (FRENCH PART) (MAF) (+590)
SAINT VINCENT AND THE GRENADINES (VCT) (+1)
SAMOA (WSM) (+685)
SAN MARINO (SMR) (+378)
SAO TOME AND PRINCIPE (STP) (+239)
SAUDI ARABIA (SAU) (+966)
SENEGAL (SEN) (+221)
SERBIA (SRB) (+381)
SERBIA AND MONTENEGRO (SCG) (+381)
SEYCHELLES (SYC) (+248)
SIERRA LEONE (SLE) (+232)
SINGAPORE (SGP) (+65)
SINT MAARTEN (DUTCH PART) (SXM) (+1)
SLOVAKIA (SVK) (+421)
SLOVENIA (SVN) (+386)
SOLOMON ISLANDS (SLB) (+677)
SOMALIA (SOM) (+252)
SOUTH AFRICA (ZAF) (+27)
SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS (SGS) (+500)
SOUTH KOREA (KOR) (+82)
SOUTH SUDAN (SSD) (+211)
SPAIN (ESP) (+34)
SRI LANKA (LKA) (+94)
ST. HELENA (SHN) (+290)
ST. PIERRE AND MIQUELON (SPM) (+508)
SUDAN (SDN) (+249)
SURINAME (SUR) (+597)
SVALBARD AND JAN MAYEN ISLANDS (SJM) (+47)
SWAZILAND (SWZ) (+268)
SWEDEN (SWE) (+46)
SWITZERLAND (CHE) (+41)
SYRIA (SYR) (+963)
TAIWAN (TWN) (+886)
TAJIKISTAN (TJK) (+992)
TANZANIA (TZA) (+255)
THAILAND (THA) (+66)
TIMOR-LESTE (TLS) (+670)
TOGO (TGO) (+228)
TOKELAU (TKL) (+690)
TONGA (TON) (+676)
TRINIDAD AND TOBAGO (TTO) (+1)
TUNISIA (TUN) (+216)
TURKEY (TUR) (+90)
TURKMENISTAN (TKM) (+993)
TURKS AND CAICOS ISLANDS (TCA) (+1)
TUVALU (TUV) (+688)
UGANDA (UGA) (+256)
UKRAINE (UKR) (+380)
UNITED ARAB EMIRATES (ARE) (+971)
UNITED KINGDOM (GBR) (+44)
UNITED STATES (USA) (+1)
UNITED STATES MINOR OUTLYING ISLANDS (UMI) (+1)
URUGUAY (URY) (+598)
UZBEKISTAN (UZB) (+998)
VANUATU (VUT) (+678)
VATICAN CITY STATE (HOLY SEE) (VAT) (+379)
VENEZUELA (VEN) (+58)
VIETNAM (VNM) (+84)
VIRGIN ISLANDS (BRITISH) (VGB) (+1)
VIRGIN ISLANDS (U.S.) (VIR) (+1)
WAKE ISLAND (WAK) (+808)
WALLIS AND FUTUNA ISLANDS (WLF) (+681)
WESTERN SAHARA (ESH) (+212)
YEMEN (YEM) (+967)
ZAIRE (ZAR) (+243)
ZAMBIA (ZMB) (+260)
ZIMBABWE (ZWE) (+263)
Phone Number
*
If you do not have a point of contact telephone number you may enter zeros.
EMERGENCY CONTACT INFORMATION IN OR OUT OF THE U.S.
Enter your emergency point of contact who may be a person in or outside of the United States, e.g., a family member, friend, or business associate. If you have no emergency contact, enter UNKNOWN.
Family Name
*
First Name
*
E-mail Address
*
Country Code
*
Country Code
AFGHANISTAN (AFG) (+93)
ALAND ISLANDS (ALA) (+358)
ALBANIA (ALB) (+355)
ALGERIA (DZA) (+213)
AMERICAN SAMOA (ASM) (+1)
ANDORRA (AND) (+376)
ANGOLA (AGO) (+244)
ANGUILLA (AIA) (+1)
ANTARCTICA (ATA) (+672)
ANTIGUA AND BARBUDA (ATG) (+1)
ARGENTINA (ARG) (+54)
ARMENIA (ARM) (+374)
ARUBA (ABW) (+297)
AUSTRALIA (AUS) (+61)
AUSTRIA (AUT) (+43)
AZERBAIJAN (AZE) (+994)
BAHAMAS (BHS) (+1)
BAHRAIN (BHR) (+973)
BANGLADESH (BGD) (+880)
BARBADOS (BRB) (+1)
BELARUS (BLR) (+375)
BELGIUM (BEL) (+32)
BELIZE (BLZ) (+501)
BENIN (BEN) (+229)
BERMUDA (BMU) (+1)
BHUTAN (BTN) (+975)
BOLIVIA (BOL) (+591)
BONAIRE, SINT EUSTATIUS AND SABA (BES) (+599)
BOSNIA AND HERZEGOVINA (BIH) (+387)
BOTSWANA (BWA) (+267)
BOUVET ISLAND (BVT) (+55)
BRAZIL (BRA) (+55)
BRITISH INDIAN OCEAN TERRITORY (IOT) (+246)
BRUNEI (BRN) (+673)
BULGARIA (BGR) (+359)
BURKINA FASO (BFA) (+226)
BURMA (BUR) (+95)
BURUNDI (BDI) (+257)
CAMBODIA (KHM) (+855)
CAMEROON (CMR) (+237)
CANADA (CAN) (+1)
CANTON AND ENDERBURY ISLANDS (CTE) (+686)
CAPE VERDE (CPV) (+238)
CAYMAN ISLANDS (CYM) (+1)
CENTRAL AFRICAN REPUBLIC (CAF) (+236)
CHAD (TCD) (+235)
CHILE (CHL) (+56)
CHINA (CHN) (+86)
CHRISTMAS ISLAND (CXR) (+61)
COCOS (KEELING) ISLANDS (CCK) (+61)
COLOMBIA (COL) (+57)
COMOROS (COM) (+269)
CONGO, DEMOCRATIC REPUBLIC OF (COD) (+243)
CONGO, REPUBLIC OF (COG) (+242)
COOK ISLANDS (COK) (+682)
COSTA RICA (CRI) (+506)
COTE D'IVOIRE (CIV) (+225)
CROATIA (HRV) (+385)
CUBA (CUB) (+53)
CURACAO (CUW) (+599)
CYPRUS (CYP) (+357)
CZECH REPUBLIC (CZE) (+420)
DEMOCRATIC YEMEN (YMD) (+967)
DENMARK (DNK) (+45)
DJIBOUTI (DJI) (+253)
DOMINICA (DMA) (+1)
DOMINICAN REPUBLIC (DOM) (+1)
EAST TIMOR (TMP) (+670)
ECUADOR (ECU) (+593)
EGYPT (EGY) (+20)
EL SALVADOR (SLV) (+503)
EQUATORIAL GUINEA (GNQ) (+240)
ERITREA (ERI) (+291)
ESTONIA (EST) (+372)
ETHIOPIA (ETH) (+251)
FALKLAND ISLANDS (FLK) (+500)
FAROE ISLANDS (FRO) (+298)
FIJI (FJI) (+679)
FINLAND (FIN) (+358)
FRANCE (FRA) (+33)
FRANCE METROPOLITAN (FXX) (+33)
FRENCH GUIANA (GUF) (+594)
FRENCH POLYNESIA (PYF) (+689)
FRENCH SOUTHERN TERRITORIES (ATF) (+262)
GABON (GAB) (+241)
GAMBIA (GMB) (+220)
GEORGIA (GEO) (+995)
GERMANY (DEU) (+49)
GHANA (GHA) (+233)
GIBRALTAR (GIB) (+350)
GREECE (GRC) (+30)
GREENLAND (GRL) (+299)
GRENADA (GRD) (+1)
GUADELOUPE (GLP) (+590)
GUAM (GUM) (+1)
GUATEMALA (GTM) (+502)
GUERNSEY (GGY) (+44)
GUINEA (GIN) (+224)
GUINEA-BISSAU (GNB) (+245)
GUYANA (GUY) (+592)
HAITI (HTI) (+509)
HEARD AND MC DONALD ISLANDS (HMD) (+0)
HONDURAS (HND) (+504)
HONG KONG (HKG) (+852)
HUNGARY (HUN) (+36)
ICELAND (ISL) (+354)
INDIA (IND) (+91)
INDONESIA (IDN) (+62)
IRAN (IRN) (+98)
IRAQ (IRQ) (+964)
IRELAND (IRL) (+353)
ISLE OF MAN (IMN) (+44)
ISRAEL (ISR) (+972)
ITALY (ITA) (+39)
JAMAICA (JAM) (+1)
JAPAN (JPN) (+81)
JERSEY (JEY) (+44)
JOHNSTON ISLAND (JTN) (+1)
JORDAN (JOR) (+962)
KAZAKHSTAN (KAZ) (+7)
KENYA (KEN) (+254)
KIRIBATI (KIR) (+686)
KOSOVO (KVV) (+383)
KUWAIT (KWT) (+965)
KYRGYZSTAN (KGZ) (+996)
LAOS (LAO) (+856)
LATVIA (LVA) (+371)
LEBANON (LBN) (+961)
LESOTHO (LSO) (+266)
LIBERIA (LBR) (+231)
LIBYA (LBY) (+218)
LIECHTENSTEIN (LIE) (+423)
LITHUANIA (LTU) (+370)
LUXEMBOURG (LUX) (+352)
MACAU (MAC) (+853)
MACEDONIA (MKD) (+389)
MADAGASCAR (MDG) (+261)
MALAWI (MWI) (+265)
MALAYSIA (MYS) (+60)
MALDIVES (MDV) (+960)
MALI (MLI) (+223)
MALTA (MLT) (+356)
MARSHALL ISLANDS (MHL) (+692)
MARTINIQUE (MTQ) (+596)
MAURITANIA (MRT) (+222)
MAURITIUS (MUS) (+230)
MAYOTTE (MYT) (+262)
MEXICO (MEX) (+52)
MICRONESIA - FEDERATED STATES OF (FSM) (+691)
MIDWAY ISLANDS (MID) (+1)
MOLDOVA (MDA) (+373)
MONACO (MCO) (+377)
MONGOLIA (MNG) (+976)
MONTENEGRO (MNE) (+382)
MONTSERRAT (MSR) (+1)
MOROCCO (MAR) (+212)
MOZAMBIQUE (MOZ) (+258)
MYANMAR (MMR) (+95)
NAMIBIA (NAM) (+264)
NAURU (NRU) (+674)
NEPAL (NPL) (+977)
NETHERLANDS (NLD) (+31)
NETHERLANDS ANTILLES (ANT) (+599)
NEW CALEDONIA (NCL) (+687)
NEW ZEALAND (NZL) (+64)
NICARAGUA (NIC) (+505)
NIGER (NER) (+227)
NIGERIA (NGA) (+234)
NIUE (NIU) (+683)
NORFOLK ISLAND (NFK) (+672)
NORTH KOREA (PRK) (+850)
NORTHERN MARIANA ISLANDS (MNP) (+1)
NORWAY (NOR) (+47)
OMAN (OMN) (+968)
PAKISTAN (PAK) (+92)
PALAU (PLW) (+680)
PALESTINIAN TERRITORIES (PSE) (+970)
PANAMA (PAN) (+507)
PAPUA NEW GUINEA (PNG) (+675)
PARAGUAY (PRY) (+595)
PERU (PER) (+51)
PHILIPPINES (PHL) (+63)
PITCAIRN ISLANDS (PCN) (+64)
POLAND (POL) (+48)
PORTUGAL (PRT) (+351)
PUERTO RICO (PRI) (+1)
QATAR (QAT) (+974)
REUNION (REU) (+262)
ROMANIA (ROM) (+40)
RUSSIA (RUS) (+7)
RWANDA (RWA) (+250)
SAINT BARTHELEMY (BLM) (+590)
SAINT KITTS AND NEVIS (KNA) (+1)
SAINT LUCIA (LCA) (+1)
SAINT MARTIN (FRENCH PART) (MAF) (+590)
SAINT VINCENT AND THE GRENADINES (VCT) (+1)
SAMOA (WSM) (+685)
SAN MARINO (SMR) (+378)
SAO TOME AND PRINCIPE (STP) (+239)
SAUDI ARABIA (SAU) (+966)
SENEGAL (SEN) (+221)
SERBIA (SRB) (+381)
SERBIA AND MONTENEGRO (SCG) (+381)
SEYCHELLES (SYC) (+248)
SIERRA LEONE (SLE) (+232)
SINGAPORE (SGP) (+65)
SINT MAARTEN (DUTCH PART) (SXM) (+1)
SLOVAKIA (SVK) (+421)
SLOVENIA (SVN) (+386)
SOLOMON ISLANDS (SLB) (+677)
SOMALIA (SOM) (+252)
SOUTH AFRICA (ZAF) (+27)
SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS (SGS) (+500)
SOUTH KOREA (KOR) (+82)
SOUTH SUDAN (SSD) (+211)
SPAIN (ESP) (+34)
SRI LANKA (LKA) (+94)
ST. HELENA (SHN) (+290)
ST. PIERRE AND MIQUELON (SPM) (+508)
SUDAN (SDN) (+249)
SURINAME (SUR) (+597)
SVALBARD AND JAN MAYEN ISLANDS (SJM) (+47)
SWAZILAND (SWZ) (+268)
SWEDEN (SWE) (+46)
SWITZERLAND (CHE) (+41)
SYRIA (SYR) (+963)
TAIWAN (TWN) (+886)
TAJIKISTAN (TJK) (+992)
TANZANIA (TZA) (+255)
THAILAND (THA) (+66)
TIMOR-LESTE (TLS) (+670)
TOGO (TGO) (+228)
TOKELAU (TKL) (+690)
TONGA (TON) (+676)
TRINIDAD AND TOBAGO (TTO) (+1)
TUNISIA (TUN) (+216)
TURKEY (TUR) (+90)
TURKMENISTAN (TKM) (+993)
TURKS AND CAICOS ISLANDS (TCA) (+1)
TUVALU (TUV) (+688)
UGANDA (UGA) (+256)
UKRAINE (UKR) (+380)
UNITED ARAB EMIRATES (ARE) (+971)
UNITED KINGDOM (GBR) (+44)
UNITED STATES (USA) (+1)
UNITED STATES MINOR OUTLYING ISLANDS (UMI) (+1)
URUGUAY (URY) (+598)
UZBEKISTAN (UZB) (+998)
VANUATU (VUT) (+678)
VATICAN CITY STATE (HOLY SEE) (VAT) (+379)
VENEZUELA (VEN) (+58)
VIETNAM (VNM) (+84)
VIRGIN ISLANDS (BRITISH) (VGB) (+1)
VIRGIN ISLANDS (U.S.) (VIR) (+1)
WAKE ISLAND (WAK) (+808)
WALLIS AND FUTUNA ISLANDS (WLF) (+681)
WESTERN SAHARA (ESH) (+212)
YEMEN (YEM) (+967)
ZAIRE (ZAR) (+243)
ZAMBIA (ZMB) (+260)
ZIMBABWE (ZWE) (+263)
Phone
*
If you do not have an emergency contact telephone number you may enter zeros.
ELIGIBILITY QUESTIONS
1) Do you have a physical or mental disorder; or are you a drug abuser or addict; or do you currently have any of the following diseases (communicable diseases are specified pursuant to section 361(b) of the Public Health Service Act):
*
Cholera; Diphtheria; Tuberculosis, infectious; Plague; Smallpox; Yellow Fever; Viral Hemorrhagic Fevers, including Ebola, Lassa, Marburg, Crimean-Congo; Severe acute respiratory illnesses capable of transmission to other persons and likely to cause mortality.
Yes
No
2) Have you ever been arrested or convicted for a crime that resulted in serious damage to property, or serious harm to another person or government authority?
*
Yes
No
3) Have you ever violated any law related to possessing, using, or distributing illegal drugs?
*
Yes
No
4) Do you seek to engage in or have you ever engaged in terrorist activities, espionage, sabotage, or genocide?
*
Yes
No
5) Have you ever committed fraud or misrepresented yourself or others to obtain, or assist others to obtain, a visa or entry into the United States?
*
Yes
No
6) Are you currently seeking employment in the United States or were you previously employed in the United States without prior permission from the U.S. government?
*
Yes
No
7) Have you ever been denied a U.S. visa you applied for with your current or previous passport, or have you ever been refused admission to the United States or withdrawn your application for admission at a U.S. port of entry?
*
Yes
No
8) Have you ever stayed in the United States longer than the admission period granted to you by the U.S. government?
*
Yes
No
9) Have you traveled to, or been present in Iraq, Syria, Iran, Sudan, Libya, Somalia or Yemen on or after March 1, 2011?
*
Yes
No
ESTA
Credit Card
*
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