DS-160 Application Form

Photo & Confirmation

Confirmation Number

Applicant Photo

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Personal, Address, Phone, and Passport/Travel Document Information

Surname(s) / Last Name(s)

Given Name(s) / First Name(s)

Full Name in Native Language

Other Names Used (maiden, aliases, etc.)

Telecode Name Used

Sex

Marital Status

Date of Birth

Place of Birth (City, State, Country)

Country/Region of Origin (Nationality)

Do you hold any other nationality?

Are you a permanent resident of another country?

National Identification Number

U.S. Social Security Number

U.S. Taxpayer ID Number

Home Address

Street Address

Address Line 2

City

State/Province

Postal/ZIP Code

Country/Region

Same Mailing Address?

Phone and Email

Primary Phone Number

Secondary Phone Number

Work Phone Number

Email Address

Social Media

Social Media Platform

Social Media Identifier/Username

Additional social media presence?

Passport Information

Passport Type

Passport Number

Passport Book Number

Country/Authority that Issued Passport

City Where Issued

State/Province Where Issued

Country/Region Where Issued

Issuance Date

Expiration Date

Have you ever lost a passport or had one stolen?

Travel Information

Purpose of Trip to the U.S.

Specify

Have you made specific travel plans?

Intended Date of Arrival

Intended Length of Stay

Address Where You Will Stay in the U.S.

City, State, Postal/Zip Code

Person/Entity Paying for Your Trip

Who is Paying?

Person Paying (Surname, Given Names)

Payer Telephone Number

Payer Email Address

Relationship to You

Is the payer's address same as your Home Address?

Travel Companions

Are there other persons traveling with you?

Are you traveling as part of a group or organization?

Name of the Group

Previous U.S. Travel

Have you ever been in the U.S.?

Do you hold a U.S. Driver's License?

Previous U.S. Visa

Have you ever been issued a U.S. Visa?

Has your U.S. Visa ever been lost or stolen?

Has your U.S. Visa ever been cancelled or revoked?

Have you ever been refused a U.S. Visa, or been refused admission, or withdrawn your application?

Have you ever been denied ESTA?

Has anyone filed an immigrant petition on your behalf?

U.S. Contact Information

Contact Person Name in the U.S.

Organization Name in the U.S.

Relationship to You

U.S. Contact Address

Phone Number

Email Address

Family Information

Father's Information

Father's Surnames

Father's Given Names

Father's Date of Birth

Is your father in the U.S.?

Mother's Information

Mother's Surnames

Mother's Given Names

Mother's Date of Birth

Is your mother in the U.S.?

Do you have any immediate relatives (not including parents) in the U.S.?

Do you have any other relatives in the United States?

Work/Education/Training Information

Primary Occupation

Present Employer or School Name

Address

City

State/Province

Postal/ZIP Code

Country/Region

Work Phone Number

Monthly Salary in Local Currency

Briefly Describe your Duties

Were you previously employed?

Education

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

Additional Information

Do you belong to a clan or tribe?

Languages You Speak (comma-separated)

Have you traveled to any countries within the last five years?

Have you belonged to any professional, social, or charitable organization?

Do you have any specialized skills (firearms, explosives, etc.)?

Have you ever served in the military?

Have you ever been involved with a paramilitary, rebel, guerrilla, or insurgent organization?

Location Information

Current Location (City, Country)

Preparer of Application

Did anyone assist you in filling out this application?

DS-160 Application Form Generator