DS-156 Consolidated Nonimmigrant Visa Application

Online Application for Nonimmigrant Visa

DS-156

OMB: 1405-0182

Document [pdf]
Download: pdf | pdf
OMB APPROVAL NO 1405-0018
EXPIRATION DATE XX/XX/20XX
ESTIMATED BURDEN: 90 MINUTES

U.S. Department of State

CONSOLIDATED NONIMMIGRANT VISA APPLICATION

PLEASE TYPE OR PRINT YOUR ANSWERS IN THE SPACE PROVIDED BELOW EACH ITEM

PASSPORT INFORMATION
Surname (as on passport)

Passport Travel Document
Type

First and Middle Names (as on passport)

Passport Number

Issuing Country

Place of Issuance - City

Place of Issuance - Country

Issuance Date (mm-dd-yyyy)

Place of Issuance
State/Province

Expiration Date (mm-dd-yyyy)

Have you ever lost a passport or had one stolen? If Yes, Please Provide Passport/Travel Document Country/Authority that Issued Passport/Travel
Number
Document
Yes
No
Explain

BIOGRAPHICAL INFORMATION
Other Surnames Used (Maiden, Religious, Professional, Aliases)

Other First and Middle Names Used

Full Name in Native Alphabet

Place of Birth

Date of Birth (mm-dd-yyyy)

Sex
Male

City

Nationality

National Identification Number (if applicable)

Female

Country

State/Province

Country/Region of Origin (nationality)

Yes
No
Do you hold or have you held any nationality other than the one indicated above on nationality?
If Yes, Please Provide Name of Country/Region
If you hold a passport for the other country/region of origin/nationality,
please enter passport number.

Are you a permanent resident of a country/region other than your country or origin/region (nationality) form above?
If yes, please enter the Other Permanent Resident Country/Region.

Yes

No

ADDRESS INFORMATION
Please provide the following
information regarding your home
address.

Apartment Number

Street

City

State/Province

Postal Zone

Country

Is your mailing address your home address? If no, please provide the following information.
Apartment Number
Street

City

Please provide the following
information.

Country

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03-2018

State/Province

Postal Zone

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PHONE INFORMATION AND EMAIL
Primary Phone Number

Secondary Phone Number

Work Number

Mobile/Cell Number

Have you used any other telephone numbers during the last five years? (If "Yes", list additional telephone numbers used in the space below.)
Yes

No

Email Address

Have you used any other email addresses during the last five years? (If "Yes", list additional email addresses used in the space below.)
Yes

No

SOCIAL MEDIA
Have you used any of the following social media platforms during the last five years? (If "Yes", provide social media identifier for platform.)
Platform

Answer

Social Media Identifier(s)

Ask.fm

Yes

No

Douban

Yes

No

Facebook

Yes

No

Flickr

Yes

No

Google+

Yes

No

Instagram

Yes

No

LinkedIn

Yes

No

Myspace

Yes

No

Pinterest

Yes

No

Qzone (QQ)

Yes

No

Reddit

Yes

No

Sina Weibo

Yes

No

Tencent Weibo

Yes

No

Tumbler

Yes

No

Twitter

Yes

No

Twoo

Yes

No

Vine

Yes

No

Vkontakte

Yes

No

Youku

Yes

No

YouTube

Yes

No

None of the Above

Yes

No

SOCIAL MEDIA - Optional
If you would like to provide information about your presence on any other websites or applications you have used within the last five years to create or
share content (photos, videos, status updates, etc.), please list the platform and associated unique social media identifier (username or handle) below.
Platform

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Social Media Identifier(s)

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TRAVEL INFORMATION (Please provide the following information concerning your travel plans.)
Purpose of the Trip to the United States

Specify

Person/Entity Paying for Your Trip

Surname of Person Paying for Your Trip

Given Names of Person Paying for Your Trip

Telephone of Person Paying for Your Trip

Email Address of Person Paying for Your Trip

Relationship to You

Intended Length of Stay in the U.S.
Intended Date of Arrival (mm-dd-yyyy)

Is the address of the party paying for your trip the same as your mailing address?
Yes
If no, please provide street address, city, state/province, postal zone/ZIP code, country/region.

No
Intended Arrival Flight Number (if known)

Intended Date of Departure (mm-dd-yyyy)

Departure Flight Number (if known)

Departure City

Please Provide Street Address of Where You
Intend to Stay

City/State

Zip Code

Are there persons traveling with you?

If yes, please provide the surname and given
name of person traveling with you.

Relationship with the Person

Yes

No

Are you traveling as part of a group or
organization?
Yes
No

If yes, please provide the name of the group you are traveling with.

PURPOSE OF TRIP TO UNITED STATES
If your purpose of travel is to come as a Student/Exchange Visitor (F1, F3, J1, M1, M3) please provide additional Point of Conact 1, additional Point of
Contact 2 and Sevis information.
Additional Point of Contact 1
Surname

Given Name

Street Address (line 1)

Street Address (line 2)

City

State/Province

Postal Zone/Zip Code

Country/Region

Telephone Number

Email Address

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Additional Point of Contact 2
Surname

Given Name

Street Address (line 1)

Street Address (line 2)

City

State/Province

Postal Zone/Zip Code

Country/Region

Telephone Number

Email Address

SEVIS INFORMATION
SEVIS ID

Principal Applicant SEVIS ID (if applicable)

Program Number (J1)

Do you intend to Study in the U.S.?

Name of School

Course of Study

Street Address (line 1)

Street Address (line 2)

City

State

Yes

No

If yes, explain

Postal Zone/Zip Code

If Your Purpose of Travel is to Come as a CREW MEMBER IN TRANSIT (C1/D) OR CREWMEMBER (D), Please Provide the Following Information
Specific Job Title Aboard Aircraft of Vessel
Company Telephone Number

Name of Company that Owns the Aircraft or Vessel you will be Working on

Did you acquire your position using a recruiting/manning/crewing agency?
Agency Name

Contact Given Name

State

Did you acquire your position using a recruiting/manning/crewing agency?

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If yes, please provide the following:

Street Address (line 2)

Country/Region

Seagoing Ship/Vessel Name

No

Contact Surname

Street Address (line 1)

City

Yes

Postal Zone/Zip Code

Telephone Number

Yes

If yes, please provide the following:

Seagoing Ship/Vessel Identification Number

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Please fill out one of the following boxes depending on your Temporary Work Visa Class.
Temporary Work Visa information for A1, A2, (A3), E3, E3R, G5, H1B1, l, NATO1-NATO6 (NATO7), Q, TN Visa Applicants
Name of Employer

Monthly Income

U.S. Street Address (line 1)

U.S. Street Address (line 2)

City

State

Zip Code

Country Region

Phone Number

OR..
Temporary Work Visa Information for CW1, E2C, H1B, H1C, H2A, H2B, H3, L1, O1, O2, P1, P2, P3, R1 Visa Applicants
Application Receipt/Petition Number

Name of Person/Company who Filed Petition

Name of Employer

Monthly Income

U.S. Street Address (line 1)

U. S. Street Address (line 2)

City

State

Zip Code

Phone Number

Phone Number

OR..
Temporary Work Visa Information for E1or E2 Visa Applicants
Name of Employer

E Visa Company Registration Number

U.S. Street Address (line 1)

U. S. Street Address (line 2)

City

State

Phone Number

PREVIOUS U.S. TRAVEL INFORMATION
(Please provide the following previous U.S. travel information. Provide complete and accurate information to all questions that require an explanation.)
Did you acquire your position using a recruiting/manning/crewing agency?
Yes
No
If yes, please provide information on your last five U.S. visits.
Date of Arrival
(mm-dd-yyyy)

1.

2.

3.

4.

5.

Length of "Stay
If you have ever visited the U.S. please answer the following questions.
Have you ever been the subject of a removal or deportation hearing?

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Yes

No

If yes, explain

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Have you ever sought to obtain or assist others to obtain a visa, entry into the United States, or any other United States immigration benefit by fraud or
willful misrepresentation or any other unlawful means?
Yes

No

If yes, explain.

Have you ever been unlawfully present in the U.S. for more than one year in the aggregate at any time during the past ten years?
Yes
No
If yes, explain.

Have you failed to attend a hearing on removability or or inadmissibility within the last five years?
Yes
No
If yes, explain.

Have you ever been unlawfully present, or overstayed the amount of time granted by an immigration official or otherwise violated the terms of a U.S.
Visa?
Yes
No
If yes, explain.

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

No

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

If yes, please provide the following information

Yes

No

Date last Visa was
Issued (mm-dd-yyyy)

State License Issued

Visa Number

License Number

If you were issued a U.S. Visa previously, are you applying for the same Visa?

If yes, please provide the following information.

Yes

No

a. Are you applying in the same country where the U.S. Visa above was issued?

Yes

No

b. Is this country your principal country of residence?

Yes

No

c. Have you ever been ten-printed?

Yes

No

d. Has your U.S. Visa ever been stolen?

Yes

No If yes, please provide year Visa was stolen.

Yes

No If yes, please explain.

If you were issued a U.S. Visa previously, please provide the following information

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

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f. Have you ever been removed or deported from any country?

Yes

No If yes, please explain.

h. Have you ever been refused a U.S. Visa?

Yes

No If yes, please explain.

i. Have you ever been refused admission to the United States?

Yes

No If yes, please explain.

j. Have you ever had your application for admission at the port of entry withdrawn?

Yes

No If yes, please explain.

k. Has anyone ever filed an immigrant petition on your behalf with the United States Citizenship and immigration Services?
Yes

No If yes, please explain.

l. Have you ever been denied travel authorization by the Department of Homeland Security through the Electronic System for Travel Authorization?

m. Have you ever been a U.S. legal permanent resident?

Yes

No If yes, please explain.

Yes

No If yes, please explain.

U.S. POINT OF CONTACT
Your U.S. Point of Contact can be any individual in the U.S. who knows you and can verify, if necessary, your identity. If you do not personally know
anyone in the U.S., you may enter the name of the store, company or organization you plan to visit during your trip.
Contact Person (skip if you do not know)
Surnames
Given Names

Organization (skip if you do not know)

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Organization Name

Relationship to you

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U.S. ADDRESS AND PHONE NUMBER OF POINT OF CONTACT
Street Address (line 1)

Street Address (line 2)

City

State

Phone Number

Zip Code

Email Address

FAMILY INFORMATION
Please provide the following information concerning your biological parents. If adopted, please provide the following information on your adoptive
parents.
Father's Full Name and Date of Birth
Surname

Given Names

Date of Birth (mm-dd-yyyy)

Year of Death

Is your father in the United
States?
Yes
No

Street Address (line 1)

City

Zip Code

Father's Status

Street Address (line 2)

State/Province

Country

Mother's Full Name and Date of Birth
Surname

Given Names

Date of Birth (mm-dd-yyyy)

Year of Death

Is your mother in the United
States?
Yes
No

Street Address (line 1)

City

Zip Code

Mother's Status

Street Address (line 2)

State/Province

Country

Do you have any immediate relatives, not including parents, in the United States?
Yes
No If yes please provide the following information below.
(Immediate relatives means fiancé/fiancée, spouse (husband/wife), child (son/daughter), or sibling (brother/sister)).
Surname
Given Names
Relatives Status
Relationship to You

Do you have any immediate relatives, not including parents, in the United States?
Surname

Yes

Given Names

Do you have any immediate relatives, not including parents, in the United States?
Surname

No If yes please provide the following information below
Relationship to You

Yes

Given Names

Relatives Status

No If yes please provide the following information below
Relationship to You

Relatives Status

FAMILY INFORMATION - SPOUSE
Do you have any former spouses?

Yes

No If yes, please provide former spouse information below

Surnames

Given Names

Date of Birth (mm-dd-yyyy)

City of Birth

Country/Region of Origin (nationality)

Number of Former Spouses

Date of Marriage (mm-dd-yyyy)

County/Region

Country/Region Marriage was Terminated

Date Marriage Ended (mm-dd-yyyy)

Explain how the marriage ended

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FIANCE/FIANCEE INFORMATION (If you are K-1 or K-3 applicant, please provide the following information)
Fiancé/Fiancée Full Name and Date of Birth
Surname

Given Names

Date of Birth (mm-dd-yyyy)

Occupation

Street Address (line 1)

City

Zip Code

Apt # (line 2)

State/Province

Country

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FAMILY INFORMATION - CHILDREN Please provide the following information if you are a k1, k3 applicant.
Do you have any children?
Surname

Yes

No If yes please provide information below

Given Name

Birth Date
(mm-dd-yyyy)

Birth Place

Will accompany you?

Will follow you?

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

PRESENT WORK/EDUCATION/TRAINING INFORMATION
Provide the following information concerning your current employment or education.
Primary Occupation
Profession

Present Employer or School Name

Address of Employee or School
Street Address (line 1)

Street Address (line 2)

City

State/Province

Phone Number

Postal Zone/Zip Code

Monthly Income

Country Region

Briefly Describe Your Duties

Education Degrees, Licenses, or Alternative Credentials for Your Profession

PREVIOUS WORK/EDUCATION/TRAINING INFORMATION
Provide your employment information for the last five years that you were employed, if applicable. Do not list your current employment listed elsewhere
in this application.
Were you previously employed?

Yes

No If yes please provide the following information below

Employer Name
Street Address (line 1)

Street Address (line 2)

City

State/Province

Postal Zone/Zip Code

Country Region

Telephone Number

Job Title

Supervisor's Surname

Supervisor's Given Name

Employment Date From (mm-dd-yyyy)

Employment Date To (mm-dd-yyyy)

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Employer Name
Street Address (line 1)

Street Address (line 2)

City

State/Province

Postal Zone/Zip Code

Country Region

Telephone Number

Job Title

Supervisor's Surname

Supervisor's Given Name

Employment Date From (mm-dd-yyyy)

Employment Date To (mm-dd-yyyy)

Briefly Describe Your Duties

Employer Name
Street Address (line 1)

Street Address (line 2)

City

State/Province

Postal Zone/Zip Code

Country Region

Telephone Number

Job Title

Supervisor's Surname

Supervisor's Given Name

Employment Date From (mm-dd-yyyy)

Employment Date To (mm-dd-yyyy)

Briefly Describe Your Duties

Employer Name
Street Address (line 1)

Street Address (line 2)

City

State/Province

Postal Zone/Zip Code

Country Region

Telephone Number

Job Title

Supervisor's Surname

Supervisor's Given Name

Employment Date From (mm-dd-yyyy)

Employment Date To (mm-dd-yyyy)

Briefly Describe Your Duties

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PREVIOUS WORK/EDUCATION/TRAINING INFORMATION - continued
Briefly Describe Your Duties

Employer Name
Street Address (line 1)

Street Address (line 2)

City

State/Province

Postal Zone/Zip Code

Country Region

Telephone Number

Job Title

Supervisor's Surname

Supervisor's Given Name

Employment Date From (mm-dd-yyyy)

Employment Date To (mm-dd-yyyy)

Briefly Describe Your Duties

Employer Name
Street Address (line 1)

Street Address (line 2)

City

State/Province

Postal Zone/Zip Code

Country Region

Telephone Number

Job Title

Supervisor's Surname

Supervisor's Given Name

Employment Date From (mm-dd-yyyy)

Employment Date To (mm-dd-yyyy)

Briefly Describe Your Duties

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

Yes

No If yes please provide the following information
below

Name of Institution

Choice of Study

Street Address (line 1)

Street Address (line 2)

City

State/Province

Postal Zone/Zip Code

Country Region

Date of Attendance From (mm-dd-yyyy)

Date of Attendance to (mm-dd-yyyy)

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

Yes

No

If yes please provide the following information
below.

Name of Institution

Choice of Study

Street Address (line 1)

Street Address (line 2)

City

State/Province

Postal Zone/Zip Code

Country Region

Date of Attendance From (mm-dd-yyyy)

Date of Attendance to (mm-dd-yyyy)

Name of Institution

Choice of Study

Street Address (line 1)

Street Address (line 2)

City

State/Province

Postal Zone/Zip Code

Country Region

Date of Attendance From (mm-dd-yyyy)

Date of Attendance to (mm-dd-yyyy)

ADDITIONAL INFORMATION
Do you belong to a clan or tribe?

Yes

No

If yes please provide the following information below.

Provide the languages you speak below.

Provide the countries you have traveled in the last five years below.

Have you belonged to, contributed to, or worked for any professional, social, or charitable organizations?
If yes please provide the names of organizations below.
Organization Names

Yes

Do you have any specialized skills or training, such as firearms, explosives, nuclear, biological, or chemical experiences?

No

Yes

No

Explain
Have you ever served in the military?

Yes

No

If yes please provide the following information below.

Country/Region

Branch of Service

Rank/Position

Military Specialty

Date of Service From (mm-dd-yyyy)

Date of Service to (mm-dd-yyyy)

Have you ever served in, been a member of, or been involved with a paramilitary unit, rebel group, guerilla group, or insurgent organization?
Yes
No If yes explain below.

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Please provide the following security and background information. Provide complete and accurate information to all questions that require
an explanation. A visa may not be issued to persons who are within specific categories defined by law as inadmissible to the United States
(except when a waiver is obtained in advance). Are any of the following applicable to you? While a YES answer does not automatically
ineligibility for a visa, if you answer YES you may be required to personally appear before a consular officer.
Do you have a communicable disease of public health significance? (Communicable diseases of public significance include cancroid, gonorrhea,
granuloma, inguinale, infectious leprosy, lymphogranuloma venereum, infectious stage syphilis, active tuberculosis, and other diseases as determined
by the Department of Health and Human Services.)
Yes

No

If yes explain below.

Do you have a mental or physical disorder that poses or is likely to pose a threat to the safety or welfare of yourself or others?
Yes

No

If yes explain below.

Are you or have you ever been a drug abuser or addict?
Yes

No

If yes explain below.

Do you have documentation to establish that you have received vaccinations in accordance with U.S law?
Yes

No

If yes explain below.

Have you ever been arrested or convicted for any offense or crime, even though subject of a pardon, amnesty, or other similar offense?
Yes

No

If yes explain below.

Have you ever violated, or engaged in a conspiracy to violate, any law relating to controlled substance?
Yes

No

If yes explain below.

Are you coming to the United States to engage in prostitution or unlawful commercialized vice or have you been engaged in prostitution or procuring
prostitutes within the past 10 years?
Yes

No

If yes explain below.

Have you ever been involved in, or do you seek to engage in, money laundering?
Yes

No

If yes explain below.

Have you ever committed or conspired to commit a human trafficking offense in the United States or outside the United States?
Yes

No

If yes explain below.

Have you ever knowingly aided, abetted, assisted or colluded with an individual who has committed, or conspired to commit a severe human trafficking
offense in the United States or outside the United States?
Yes

No

If yes explain below.

Are you the spouse, son, or daughter of an individual who has committed or conspired to commit a human trafficking offense in the United States or
outside the United States and have you within the last five years, knowingly benefited from the trafficking activities?
Yes

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No

If yes explain below.

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Are you the spouse, son, or daughter of an individual who has been identified by the President of the United States as a person who plays a significant
role in a severe form of trafficking in persons and have you, with the the last five years, knowingly benefited from the trafficking activities?
Yes
No If yes explain below.

Are you the spouse, son or daughter of an individual who has violated any controlled substance trafficking law, and has knowingly benefited from the
trafficking in the past five years?
Yes
No If yes explain below.

Do you seek to engage in espionage, sabotage, export control violations or any other illegal activity in the United States?
Yes

No

If yes explain below.

Have you or do you intend to provide financial assistance or other support to terrorist or terrorist organizations?
Yes

No

If yes explain below.

Are you a member or representative of a terrorist organization?
Yes

No

If yes explain below.

Are you the spouse, son, or daughter of an individual who has engaged in terrorist activity, including providing financial assistance or other support to
terrorists or terrorist organizations, in the last five years?
Yes
No If yes explain below.

Have you ever ordered, incited, committed, assisted, or otherwise participated in genocide?
Yes

No

If yes explain below.

Have you ever been directly involved in the coercive transplantation of human organs or bodily tissue?
Yes

No

If yes explain below.

Have you ever committed, or tortured, incited, assisted, or otherwise participated in torture?
Yes

No

If yes explain below.

Have you committed, ordered, incited, assisted, or otherwise participated in extrajudicial killings, political killings, or other acts of violence?
Yes

No

If yes explain below.

Have you ever engaged in the recruitment or the use of child soldiers?
Yes

No

If yes explain below.

Have you, while serving as a government official, been responsible for or directly carried out, at any time, particularly severe violations of religious
freedom?
Yes
No If yes explain below.

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Have you ever been directly involved in the establishment or enforcement of population controls forcing a woman to undergo an abortion against her
free choice or a man or a woman to undergo sterilization against his or her free will?
Yes
No If yes explain below.

Have you been ordered removed from the U.S. during the last five years?
Yes

No

If yes explain below.

Have you ever sought to obtain or assist others to obtain a visa, entry into the United States, or any other United States immigration benefit by fraud or
willful misrepresentation or other unlawful means?
Yes
No If yes explain below.

Are you subject to a civil penalty under INA 274C?
Yes

No

If yes explain below.

Have you been ordered removed from the U.S. for a second time within the last 20 years?
Yes

No

If yes explain below.

Have you ever been convicted of an aggravated felony and been order removed from the U.S.?
Yes

No

If yes explain below.

Have you ever been unlawfully present in the U.S. for more than 180 days (but no more than one year) and have voluntarily departed the U.S. within
the last three years?
Yes
No If yes explain below.

Have you ever been unlawfully present in the U.S. for more than one year in the aggregate at any time during the past ten years?
Yes

No

If yes explain below.

Have you ever withheld custody of a U.S. citizen child outside the United States from a person granted legal custody by a U.S. court?
Yes

No

If yes explain below.

Have you ever voted in the United States in violation of any law or regulation?
Yes

No

If yes explain below.

Have you ever renounced United States citizenship for the purposes of avoiding taxation?
Yes

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No

If yes explain below.

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Have you attended a public elementary school on student (F) status or a public secondary school after November 30, 1996 without reimbursing the
school?
Yes
No If yes explain below.

Are you a former exchange visitor who has not yet fulfilled the two year foreign residence requirement?
Yes

No

If yes explain below.

Do you seek to enter the United States for purpose of performing skilled or unskilled labor but have not yet been certified by the Secretary of Labor?
Yes

No

If yes explain below.

Are you a graduate of a foreign medical school seeking to perform medical services in the United States but have not yet passed the National Board of
Medical Examiners examination or its equivalent?
Yes
No If yes explain below.

Are you a healthcare worker seeking to perform such work in the United States but have not yet received certification from the Commission on
Graduates of Foreign Nursing Schools or from an equivalent approved independent credentialing organization?
Yes
No If yes explain below.

Are you permanently ineligible for U.S. citizenship?
Yes

No

If yes explain below.

Have you ever departed the United States in order to evade military service during a time of war?
Yes

No

If yes explain below.

Are you coming to the U.S. to practice polygamy?
Yes

No

If yes explain below.

Has an immigration judge or the Board of Immigration Appeals ever determined that you had knowingly made a frivolous application for asylum?
Yes

No

If yes explain below.

Are you a member of or affiliated with the Communist or other totalitarian party?
Yes

No

If yes explain below.

Have you ever directly or indirectly assisted or supported any of the groups in Colombia known as the Revolutionary Armed Forces of Colombia
(FARC), National Liberation Army (ELN), or United Self-Defense Forces of Colombia (AUC)?
Yes
No If yes explain below.

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Have you ever through abuse of governmental or political position converted for personal gain, confiscated or expropriated property in a foreign nation
to which a United States national had claim of ownership?
Yes
No If yes explain below.

Are you the spouse, minor child, or agent of an individual who has through abuse of governmental or political position converted for personal gain,
confiscated, or expropriated property in a foreign nation to which a United States national had claim of ownership?
Yes

No

If yes explain below.

Have you ever disclosed or trafficked in confidential U.S. business information obtained in connection with U.S. participation in the Chemical Weapons
Convention?
Yes
No If yes explain below.

Are you the spouse, minor child, or agent of an individual who has disclosed or trafficked in confidential U.S. business information obtained in
connection with U.S. participation in the Chemical Weapons Convention?
Yes
No If yes explain below.

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PLEASE READ THE INFORMATION CAREFULLY BEFORE SIGNING AND SUBMITTING YOUR APPLICATION
The information that you have provided in your application and other information submitted with you application may be accessible to other government
agencies having statutory or other lawful authority to use such information, including for law enforcement and immigration law enforcement purposes.
The photograph that you provided with your application may be used for employment verification or other U.S. law purposes.
Applicant's Signature ___________________________________________________

I understand that I am required to submit my visa to the United States Immigration Officer at the place where I apply to enter the United States, and that
the possession of a visa does not entitle me to enter the United States if at that time I am found inadmissible under the immigration laws.
Applicant's Signature ___________________________________________________

I understand that any willfully false or misleading statement or willful concealment of a material fact made by me herein may subject me to permanent
exclusion from the United States and, if I am admitted to the United States, may subject me to criminal prosecution and or/deportation.
Applicant's Signature ___________________________________________________

Nonimmigrant Fiancé(e) Applicant: I hereby certify that I am legally free to marry and intend to marry
a U.S. Citizen, within 90 days of my admission into the United States.
Applicant's Signature ___________________________________________________

I do solemnly swear or affirm that all statements which appear in this application have been made by me and are true and complete to best of my
knowledge and belief.
Applicant's Signature ___________________________________________________

Was this application prepared by another person on your behalf? If yes please have that person complete provide the information below

Application Prepared by

Relationship to Applicant

Address

Signature of Person Preparing Form ___________________________________________________

Date (mm-dd-yyyy)

Paperwork Reduction Act Statement
Public reporting burden for this collection of information is estimated to average 90 minutes per response, including time required for searching existing
data sources, gathering the necessary documentation, providing the information and/or documents required, and reviewing the final collection. You do
not have to supply this information unless this collection displays a currently valid OMB control number. If you have comments on the accuracy of this
burden estimate and/or recommendations for reducing it, please send them to: A/GIS/DIR, Room 2400 SA-22, U.S. Department of State, Washington,
DC 20522-2202.
Confidentiality Statement
INA Section 222(f) provides that visa issuance and refusal records shall be considered confidential and shall be used only for the formulation,
amendment, administration, or enforcement of the immigration, nationality, and other laws of the United States. Certified copies of visa records may be
made available to a court which certifies that the information contained in such records is needed in a case pending before the court.

DS-0156

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File Typeapplication/pdf
File TitleDS-0156
AuthorTaylorC2
File Modified2018-08-07
File Created2018-08-07

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