DS-5501 Electronic Diversity Visa Entry Form , Part One (5/14/07

Top of Form

ELECTRONIC DIVERSITY VISA ENTRY FORM

Approved OMB 1405-0153
Expires: 04/30/2007
Estimated Burden: 30 minutes

Part One - Applicant Information

1. Name

a. Last/Family Name

No Last/Family Name

b. First Name

No First Name

c. Middle Name

No Middle Name

2. Birth Date

3. Gender

Male

Female

 

4. City Where You Were Born

Birth City/Town Unknown

5. Country Where You Were Born

6. Country of Eligibility for the DV Program

Are you claiming eligibility based on your Birth Country?

Yes

No

Your country of eligibility will normally be the same as your country of birth. Your country of eligibility is not related to where you live. If you were born in a country that is not eligible for the DV program, please go to (Explanation of Country of Eligibility) to see if there is another option available in your case.

If not, you must enter the country from which you are claiming eligibility.

7. Entrant Photograph

Photographs must be submitted at the time of E-DV entry. Photographs that do not comply with all specifications, including but not limited to recency of the photos, composition of the photos, and unacceptable backgrounds are grounds for disqualification of the entire entry. Any manipulation of photographs that alters the facial characteristics is grounds for disqualification of the entire entry. See examples on the Photo Validation page.

Please refer to the Instructions for the 2008 Diversity Immigrant Visa Program (DV-2008) for technical specifications and compositional specifications for the digital image.

You will use one of the following methods to enter the image into eDV:

• Take a new digital image.

• Use a digital scanner to scan a submitted photograph.

Link to photo instructions/photo validation page

Photograph File Name

If you know the location in the computer and the name of the file which is storing the photograph, enter in the box to the left of(the) "Browse" button. If you are not sure of the location in the computer or the name of the file, clicking the "Browse" button will allow you to look for and choose the file which is storing the photograph, and after you choose the file its name will appear in the box on the left.

8. Mailing Address

8a. In Care Of
8b. Address Line 1
8c. Address Line 2
8d. City/Town
8e. District/County/Province/State
8f. Postal Code/Zip Code	No Postal Code/Zip Code
8g. Country
(NOTE: This is the address that will be used to notify you if you are selected.)

9. Country Where You Live Today

10. Phone Number

Optional

11. E-mail Address

Electronic delivery of DV correspondence may be offered in the near future. Please enter an email address in the box below if you would prefer to receive correspondence electronically.
Optional

12. Select the highest level of education you have achieved, as of today.

Primary school only	Some Graduate Level courses
High School, no degree	Masters Degree
High School degree	Some Doctorate level Courses
Vocational School	Doctorate Degree
Some University Courses
University Degree

You must have a minimum of a high school diploma reflecting the completion of a full course of study (vocation schools or equivalency degrees are not acceptable) or be a skilled worker in an occupation that requires at least two years of training or experience to qualify(see http://online.onetcenter.org/ to see if your occupation qualifies) for a Diversity Visa.

13. What is your current marital status?

Unmarried (no spouse info required)

Married (spouse info required)

Divorced (no spouse info required)

Widowed (no spouse info required)

Legally Separated (no spouse info required)

Legal separation means that a court has formally declared that you and your spouse are legally separated. Legal separation means that your spouse would not be eligible to immigrate as your derivative.

14. Number of Children

Children include all biological children, legally adopted children, and stepchildren regardless of whether they live with you and/or intend to apply for a visa as your derivative who are unmarried and under the age of 21 on the date that you submit your entry. Failure to include all children or inclusion of children who are not your biological children, legally adopted children, and stepchildren is grounds for disqualification of the entire entry.

Legal Permanent Residents (LPR) and American Citizens should not be included.

DS-5501

PRIVACY ACT AND PAPERWORK REDUCTION ACT STATEMENTS

The information asked for on this form is requested pursuant to Section 222 of the Immigration and Nationality Act. The U.S. Department of State uses the facts you provide on this form primarily to determine your eligibility for a U.S. immigrant visa. Individuals who fail to submit this form or who do not provide all the requested information may be denied a U.S. immigrant visa. If you are issued an immigrant visa and are subsequently admitted to the United States as an immigrant, the Bureau of Citizenship and Immigration Services will use the information on this form to issue you a Permanent Resident Card, and, if you so indicate, the Social Security Administration will use the information to issue you a social security number and card.

*Public reporting burden for this collection of information is estimated to average 30 minutes per response, including time required for searching existing data sources, gathering the necessary data, providing the
information required, and reviewing the final collection. In accordance with 5 CFR 1320 5(b), persons are not required to respond to the collection of this information unless this form displays a currently valid OMB control number. Send comments on the accuracy of this estimate of the burden and recommendations for reducing it to: U.S. Department of State (A/ISS/DIR) Washington, D.C. 20520.

Bottom of Form

Copyright Information