Form DS-260G Gold Visa Application

DS-260G
GOLD
IV Application
SAMPLE

August 2025

SBU - IMMIGRATION

Since the original creation of this exemplar, each Gold IV Application page now includes the following:

A header with options, "Dashboard" and "Sign & Submit"

The Consular Affairs logo in the bottom left.

Sign in Page

3

Getting Started Page

4

Personal Information: Personal Information 1
Displayed for all applicants. Answered “No” to “Have you ever used other names (i.e., maiden, religious,
professional, alias, etc.)?”

5

SBU - IMMIGRATION

Current Marital Status Drop Down Values
Married, Single, Widowed, Divorced, Legally Separated

Date Picker for Date Fields. (All dates use date picker or manual entry in mm/dd/yyyy format.)

Country/Region of Birth Drop Down Values
Select One, AFGHANISTAN, ALBANIA, ALGERIA, AMERICAN SAMOA, ANDORRA, ANGOLA, ANGUILLA, ANTIGUA AND BARBUDA, ARGENTINA, ARMENIA,
ARUBA, AT SEA, AUSTRALIA, AUSTRIA, AZERBAIJAN, BAHAMAS, BAHRAIN, BANGLADESH, BARBADOS, BELARUS, BELGIUM, BELIZE, BENIN, BERMUDA,
BHUTAN, BOLIVIA, BONAIRE, BOSNIA-HERZEGOVINA, BOTSWANA, BRAZIL, BRITISH INDIAN OCEAN TERRITORY, BRUNEI, BULGARIA, BURKINA FASO,
BURMA, BURUNDI, CAMBODIA, CAMEROON, CANADA, CABO VERDE, CAYMAN ISLANDS, CENTRAL AFRICAN REPUBLIC, CHAD, CHILE, CHINA,
CHRISTMAS ISLAND, COCOS KEELING ISLANDS, COLOMBIA, COMOROS, CONGO, DEMOCRATIC REPUBLIC OF THE, CONGO, REPUBLIC OF THE, COOK
ISLANDS, COSTA RICA, COTE D`IVOIRE, CROATIA, CUBA, CURACAO, CYPRUS, CZECH REPUBLIC, DENMARK, DJIBOUTI, DOMINICA, DOMINICAN
REPUBLIC, ECUADOR, EGYPT, EL SALVADOR, EQUATORIAL GUINEA, ERITREA, ESTONIA, ESWATINI, ETHIOPIA, FALKLAND ISLANDS, FAROE ISLANDS, FIJI,
FINLAND, FRANCE, FRENCH GUIANA, FRENCH POLYNESIA, FRENCH SOUTHERN AND ANTARCTIC TERRITORIES, GABON, GAMBIA, THE, GAZA STRIP,
GEORGIA, GERMANY, GHANA, GIBRALTAR, GREECE, GREENLAND, GRENADA, GUADELOUPE, GUAM, GUATEMALA, GUINEA, GUINEA - BISSAU, GUYANA,
HAITI, HEARD AND MCDONALD ISLANDS, HOLY SEE (VATICAN CITY), HONDURAS, HONG KONG BNO, HONG KONG SAR, HOWLAND ISLAND, HUNGARY,
ICELAND, IN THE AIR, INDIA, INDONESIA, IRAN, IRAQ, IRELAND, ISRAEL, ITALY, JAMAICA, JAPAN, JERUSALEM, JORDAN, KAZAKHSTAN, KENYA, KIRIBATI,
KOREA, DEMOCRATIC REPUBLIC OF (NORTH), KOREA, REPUBLIC OF (SOUTH), KOSOVO, KUWAIT, KYRGYZSTAN, LAOS, LATVIA, LEBANON, LESOTHO,
LIBERIA, LIBYA, LIECHTENSTEIN, LITHUANIA, LUXEMBOURG, MACAU, MADAGASCAR, MALAWI, MALAYSIA, MALDEN ISLAND, MALDIVES, MALI, MALTA,
MARSHALL ISLANDS, MARTINIQUE, MAURITANIA, MAURITIUS, MAYOTTE, MEXICO - AGUASCALIENTES, MEXICO – BAJA CALIFORNIA NORTE, MEXICO BAJA CALIFORNIA SUR, MEXICO - CAMPECHE, MEXICO - CHIAPAS, MEXICO - CHIHUAHUA, MEXICO - COAHUILA, MEXICO - COLIMA, MEXICO - DISTRITO
FEDERAL, MEXICO - DURANGO, MEXICO - GUANAJUATO, MEXICO - GUERRERO, MEXICO - HIDALGO, MEXICO - JALISCO, MEXICO - MICHOACAN, MEXICO
- MORELOS, MEXICO - NAYARIT, MEXICO - NUEVO LEON, MEXICO - OAXACA, MEXICO - PUEBLA, MEXICO - QUERETARO, MEXICO - QUINTANA ROO,
MEXICO - SAN LUIS POTOSI, MEXICO - SINALOA, MEXICO - SONORA, MEXICO - STATE OF MEXICO, MEXICO - TABASCO, MEXICO - TAMAULIPAS, MEXICO TLAXCALA, MEXICO - VERACRUZ, MEXICO - YUCATAN, MEXICO - ZACATECAS, MICRONESIA, MIDWAY ISLANDS, MOLDOVA, MONACO, MONGOLIA,
MONTENEGRO, MONTSERRAT, MOROCCO, MOZAMBIQUE, NAMIBIA, NAURU, NEPAL, NETHERLANDS, NEW CALEDONIA, NEW ZEALAND, NICARAGUA,
NIGER, NIGERIA, NIUE, NORFOLK ISLAND, NORTH MACEDONIA, NORTH MARIANA ISLANDS, NORTHERN IRELAND, NORWAY, OMAN, PAKISTAN, PALAU,
PALMYRA ATOLL, PANAMA, PAPUA NEW GUINEA, PARAGUAY, PERU, PHILIPPINES, PITCAIRN ISLANDS, POLAND, PORTUGAL, PUERTO RICO, QATAR,
REUNION, ROMANIA, RUSSIA, RWANDA, SABA ISLAND, SAINT MARTIN, SAMOA, SAN MARINO, SAO TOME AND PRINCIPE, SAUDI ARABIA, SENEGAL,
SERBIA, SEYCHELLES, SIERRA LEONE, SINGAPORE, SINT MAARTEN, SLOVAKIA, SLOVENIA, SOLOMON ISLANDS, SOMALIA, SOUTH AFRICA, SOUTH
GEORGIA AND THE SOUTH SANDWICH ISLAND, SOUTH SUDAN, SPAIN, SRI LANKA, ST. BARTHELEMY, ST. EUSTATIUS, ST. HELENA, ST. KITTS AND NEVIS,
ST. LUCIA, ST. PIERRE AND MIQUELON, ST. VINCENT AND THE GRENADINES, SUDAN, SURINAME, SVALBARD, SWEDEN, SWITZERLAND, SYRIA, TAIWAN,
TAJIKISTAN, TANZANIA, THAILAND, TIMOR-LESTE, TOGO, TOKELAU, TONGA, TRINIDAD AND TOBAGO, TUNISIA, TURKEY, TURKMENISTAN, TURKS AND
CAICOS ISLANDS, TUVALU, UGANDA, UKRAINE, UNITED ARAB EMIRATES, UNITED KINGDOM, UNITED STATES OF AMERICA, URUGUAY, UZBEKISTAN,
VANUATU, VENEZUELA, VIETNAM, VIRGIN ISLANDS (U.S.), VIRGIN ISLANDS, BRITISH, WAKE ISLAND, WALLIS AND FUTUNA ISLANDS, WEST BANK,
WESTERN SAHARA, YEMEN, ZAMBIA, ZIMBABWE

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Personal Information: Personal Information 1
Displayed for all applicants. Answered “Yes” to “Have you ever used other names (i.e., maiden, religious,
professional, alias, etc.)?”

Country/Region of Birth Drop Down Values
Same options as “Country/Region of Birth Drop Down Values” on Page 6

7

Personal Information: Personal Information 2
Displayed for all applicants. Answered “No” to “Do you hold or have you held any nationality other than
the one you have indicated above?”

Document Type Drop Down Values
Passport, Other Travel Document

8

Country/Region of Origin (Nationality) Drop Down Values
Select One, AFGHANISTAN, ALBANIA, ALGERIA, AMERICAN SAMOA, ANDORRA, ANGOLA, ANGUILLA, ANTIGUA AND BARBUDA, ARGENTINA, ARMENIA,
ARUBA, AT SEA, AUSTRALIA, AUSTRIA, AZERBAIJAN, BAHAMAS, BAHRAIN, BANGLADESH, BARBADOS, BELARUS, BELGIUM, BELIZE, BENIN, BERMUDA,
BHUTAN, BOLIVIA, BONAIRE, BOSNIA-HERZEGOVINA, BOTSWANA, BRAZIL, BRITISH INDIAN OCEAN TERRITORY, BRUNEI, BULGARIA, BURKINA FASO,
BURMA, BURUNDI, CAMBODIA, CAMEROON, CANADA, CABO VERDE, CAYMAN ISLANDS, CENTRAL AFRICAN REPUBLIC, CHAD, CHILE, CHINA,
CHRISTMAS ISLAND, COCOS KEELING ISLANDS, COLOMBIA, COMOROS, CONGO, DEMOCRATIC REPUBLIC OF THE, CONGO, REPUBLIC OF THE, COOK
ISLANDS, COSTA RICA, COTE D`IVOIRE, CROATIA, CUBA, CURACAO, CYPRUS, CZECH REPUBLIC, DENMARK, DJIBOUTI, DOMINICA, DOMINICAN
REPUBLIC, ECUADOR, EGYPT, EL SALVADOR, EQUATORIAL GUINEA, ERITREA, ESTONIA, ESWATINI, ETHIOPIA, FALKLAND ISLANDS, FAROE ISLANDS, FIJI,
FINLAND, FRANCE, FRENCH GUIANA, FRENCH POLYNESIA, FRENCH SOUTHERN AND ANTARCTIC TERRITORIES, GABON, GAMBIA, THE, GAZA STRIP,
GEORGIA, GERMANY, GHANA, GIBRALTAR, GREECE, GREENLAND, GRENADA, GUADELOUPE, GUAM, GUATEMALA, GUINEA, GUINEA - BISSAU, GUYANA,
HAITI, HEARD AND MCDONALD ISLANDS, HOLY SEE (VATICAN CITY), HONDURAS, HONG KONG BNO, HONG KONG SAR, HOWLAND ISLAND, HUNGARY,
ICELAND, IN THE AIR, INDIA, INDONESIA, IRAN, IRAQ, IRELAND, ISRAEL, ITALY, JAMAICA, JAPAN, JERUSALEM, JORDAN, KAZAKHSTAN, KENYA, KIRIBATI,
KOREA, DEMOCRATIC REPUBLIC OF (NORTH), KOREA, REPUBLIC OF (SOUTH), KOSOVO, KUWAIT, KYRGYZSTAN, LAOS, LATVIA, LEBANON, LESOTHO,
LIBERIA, LIBYA, LIECHTENSTEIN, LITHUANIA, LUXEMBOURG, MACAU, MADAGASCAR, MALAWI, MALAYSIA, MALDEN ISLAND, MALDIVES, MALI, MALTA,
MARSHALL ISLANDS, MARTINIQUE, MAURITANIA, MAURITIUS, MAYOTTE, MEXICO - AGUASCALIENTES, MEXICO – BAJA CALIFORNIA NORTE, MEXICO BAJA CALIFORNIA SUR, MEXICO - CAMPECHE, MEXICO - CHIAPAS, MEXICO - CHIHUAHUA, MEXICO - COAHUILA, MEXICO - COLIMA, MEXICO - DISTRITO
FEDERAL, MEXICO - DURANGO, MEXICO - GUANAJUATO, MEXICO - GUERRERO, MEXICO - HIDALGO, MEXICO - JALISCO, MEXICO - MICHOACAN, MEXICO
- MORELOS, MEXICO - NAYARIT, MEXICO - NUEVO LEON, MEXICO - OAXACA, MEXICO - PUEBLA, MEXICO - QUERETARO, MEXICO - QUINTANA ROO,
MEXICO - SAN LUIS POTOSI, MEXICO - SINALOA, MEXICO - SONORA, MEXICO - STATE OF MEXICO, MEXICO - TABASCO, MEXICO - TAMAULIPAS, MEXICO TLAXCALA, MEXICO - VERACRUZ, MEXICO - YUCATAN, MEXICO - ZACATECAS, MICRONESIA, MIDWAY ISLANDS, MOLDOVA, MONACO, MONGOLIA,
MONTENEGRO, MONTSERRAT, MOROCCO, MOZAMBIQUE, NAMIBIA, NAURU, NEPAL, NETHERLANDS, NEW CALEDONIA, NEW ZEALAND, NICARAGUA,
NIGER, NIGERIA, NIUE, NORFOLK ISLAND, NORTH MACEDONIA, NORTH MARIANA ISLANDS, NORTHERN IRELAND, NORWAY, OMAN, PAKISTAN, PALAU,
PALMYRA ATOLL, PANAMA, PAPUA NEW GUINEA, PARAGUAY, PERU, PHILIPPINES, PITCAIRN ISLANDS, POLAND, PORTUGAL, PUERTO RICO, QATAR,
REUNION, ROMANIA, RUSSIA, RWANDA, SABA ISLAND, SAINT MARTIN, SAMOA, SAN MARINO, SAO TOME AND PRINCIPE, SAUDI ARABIA, SENEGAL,
SERBIA, SEYCHELLES, SIERRA LEONE, SINGAPORE, SINT MAARTEN, SLOVAKIA, SLOVENIA, SOLOMON ISLANDS, SOMALIA, SOUTH AFRICA, SOUTH
GEORGIA AND THE SOUTH SANDWICH ISLAND, SOUTH SUDAN, SPAIN, SRI LANKA, ST. BARTHELEMY, ST. EUSTATIUS, ST. HELENA, ST. KITTS AND NEVIS,
ST. LUCIA, ST. PIERRE AND MIQUELON, ST. VINCENT AND THE GRENADINES, SUDAN, SURINAME, SVALBARD, SWEDEN, SWITZERLAND, SYRIA, TAIWAN,
TAJIKISTAN, TANZANIA, THAILAND, TIMOR-LESTE, TOGO, TOKELAU, TONGA, TRINIDAD AND TOBAGO, TUNISIA, TURKEY, TURKMENISTAN, TURKS AND
CAICOS ISLANDS, TUVALU, UGANDA, UKRAINE, UNITED ARAB EMIRATES, UNITED KINGDOM, UNITED STATES OF AMERICA, URUGUAY, UZBEKISTAN,
VANUATU, VENEZUELA, VIETNAM, VIRGIN ISLANDS (U.S.), VIRGIN ISLANDS, BRITISH, WAKE ISLAND, WALLIS AND FUTUNA ISLANDS, WEST BANK,
WESTERN SAHARA, YEMEN, ZAMBIA, ZIMBABWE

Country/Authority that Issued Document Drop Down Values
Select One, AFGHANISTAN, ALBANIA, ALGERIA, AMERICAN SAMOA, ANDORRA, ANGOLA, ANGUILLA, ANTIGUA AND BARBUDA, ARGENTINA, ARMENIA,
ARUBA, AT SEA, AUSTRALIA, AUSTRIA, AZERBAIJAN, BAHAMAS, BAHRAIN, BANGLADESH, BARBADOS, BELARUS, BELGIUM, BELIZE, BENIN, BERMUDA,
BHUTAN, BOLIVIA, BONAIRE, BOSNIA-HERZEGOVINA, BOTSWANA, BRAZIL, BRITISH INDIAN OCEAN TERRITORY, BRUNEI, BULGARIA, BURKINA FASO,
BURMA, BURUNDI, CAMBODIA, CAMEROON, CANADA, CABO VERDE, CAYMAN ISLANDS, CENTRAL AFRICAN REPUBLIC, CHAD, CHILE, CHINA,
CHRISTMAS ISLAND, COCOS KEELING ISLANDS, COLOMBIA, COMOROS, CONGO, DEMOCRATIC REPUBLIC OF THE, CONGO, REPUBLIC OF THE, COOK
ISLANDS, COSTA RICA, COTE D`IVOIRE, CROATIA, CUBA, CURACAO, CYPRUS, CZECH REPUBLIC, DENMARK, DJIBOUTI, DOMINICA, DOMINICAN
REPUBLIC, ECUADOR, EGYPT, EL SALVADOR, EQUATORIAL GUINEA, ERITREA, ESTONIA, ESWATINI, ETHIOPIA, FALKLAND ISLANDS, FAROE ISLANDS, FIJI,
FINLAND, FRANCE, FRENCH GUIANA, FRENCH POLYNESIA, FRENCH SOUTHERN AND ANTARCTIC TERRITORIES, GABON, GAMBIA, THE, GAZA STRIP,
GEORGIA, GERMANY, GHANA, GIBRALTAR, GREECE, GREENLAND, GRENADA, GUADELOUPE, GUAM, GUATEMALA, GUINEA, GUINEA - BISSAU, GUYANA,
HAITI, HEARD AND MCDONALD ISLANDS, HOLY SEE (VATICAN CITY), HONDURAS, HONG KONG BNO, HONG KONG SAR, HOWLAND ISLAND, HUNGARY,
ICELAND, IN THE AIR, INDIA, INDONESIA, IRAN, IRAQ, IRELAND, ISRAEL, ITALY, JAMAICA, JAPAN, JERUSALEM, JORDAN, KAZAKHSTAN, KENYA, KIRIBATI,
KOREA, DEMOCRATIC REPUBLIC OF (NORTH), KOREA, REPUBLIC OF (SOUTH), KOSOVO, KUWAIT, KYRGYZSTAN, LAOS, LATVIA, LEBANON, LESOTHO,
LIBERIA, LIBYA, LIECHTENSTEIN, LITHUANIA, LUXEMBOURG, MACAU, MADAGASCAR, MALAWI, MALAYSIA, MALDEN ISLAND, MALDIVES, MALI, MALTA,
MARSHALL ISLANDS, MARTINIQUE, MAURITANIA, MAURITIUS, MAYOTTE, MEXICO - AGUASCALIENTES, MEXICO – BAJA CALIFORNIA NORTE, MEXICO BAJA CALIFORNIA SUR, MEXICO - CAMPECHE, MEXICO - CHIAPAS, MEXICO - CHIHUAHUA, MEXICO - COAHUILA, MEXICO - COLIMA, MEXICO - DISTRITO
FEDERAL, MEXICO - DURANGO, MEXICO - GUANAJUATO, MEXICO - GUERRERO, MEXICO - HIDALGO, MEXICO - JALISCO, MEXICO - MICHOACAN, MEXICO
- MORELOS, MEXICO - NAYARIT, MEXICO - NUEVO LEON, MEXICO - OAXACA, MEXICO - PUEBLA, MEXICO - QUERETARO, MEXICO - QUINTANA ROO,
MEXICO - SAN LUIS POTOSI, MEXICO - SINALOA, MEXICO - SONORA, MEXICO - STATE OF MEXICO, MEXICO - TABASCO, MEXICO - TAMAULIPAS, MEXICO TLAXCALA, MEXICO - VERACRUZ, MEXICO - YUCATAN, MEXICO - ZACATECAS, MICRONESIA, MIDWAY ISLANDS, MOLDOVA, MONACO, MONGOLIA,
MONTENEGRO, MONTSERRAT, MOROCCO, MOZAMBIQUE, NAMIBIA, NAURU, NEPAL, NETHERLANDS, NEW CALEDONIA, NEW ZEALAND, NICARAGUA,
NIGER, NIGERIA, NIUE, NORFOLK ISLAND, NORTH MACEDONIA, NORTH MARIANA ISLANDS, NORTHERN IRELAND, NORWAY, OMAN, PAKISTAN, PALAU,
PALMYRA ATOLL, PANAMA, PAPUA NEW GUINEA, PARAGUAY, PERU, PHILIPPINES, PITCAIRN ISLANDS, POLAND, PORTUGAL, PUERTO RICO, QATAR,
REUNION, ROMANIA, RUSSIA, RWANDA, SABA ISLAND, SAINT MARTIN, SAMOA, SAN MARINO, SAO TOME AND PRINCIPE, SAUDI ARABIA, SENEGAL,
SERBIA, SEYCHELLES, SIERRA LEONE, SINGAPORE, SINT MAARTEN, SLOVAKIA, SLOVENIA, SOLOMON ISLANDS, SOMALIA, SOUTH AFRICA, SOUTH
GEORGIA AND THE SOUTH SANDWICH ISLAND, SOUTH SUDAN, SPAIN, SRI LANKA, ST. BARTHELEMY, ST. EUSTATIUS, ST. HELENA, ST. KITTS AND NEVIS,
ST. LUCIA, ST. PIERRE AND MIQUELON, ST. VINCENT AND THE GRENADINES, SUDAN, SURINAME, SVALBARD, SWEDEN, SWITZERLAND, SYRIA, TAIWAN,
TAJIKISTAN, TANZANIA, THAILAND, TIMOR-LESTE, TOGO, TOKELAU, TONGA, TRINIDAD AND TOBAGO, TUNISIA, TURKEY, TURKMENISTAN, TURKS AND
CAICOS ISLANDS, TUVALU, UGANDA, UKRAINE, UNITED ARAB EMIRATES, UNITED KINGDOM, UNITED STATES OF AMERICA, URUGUAY, UZBEKISTAN,
VANUATU, VENEZUELA, VIETNAM, VIRGIN ISLANDS (U.S.), VIRGIN ISLANDS, BRITISH, WAKE ISLAND, WALLIS AND FUTUNA ISLANDS, WEST BANK,
WESTERN SAHARA, YEMEN, ZAMBIA, ZIMBABWE

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Personal Information: Personal Information 2
Displayed for all applicants. Answered “Yes” to “Do you hold or have you held any nationality other than the one you have indicated above?”, and
“No” to “Have you owned any other passports within the past fifteen years that have not already been mentioned above?”

Country/Region of Issuance Drop Down Values
Select One, AFGHANISTAN, ALBANIA, ALGERIA, AMERICAN SAMOA, ANDORRA, ANGOLA, ANGUILLA, ANTIGUA AND BARBUDA, ARGENTINA, ARMENIA,
ARUBA, AUSTRALIA, AUSTRIA, AZERBAIJAN, BAHAMAS, BAHRAIN, BANGLADESH, BARBADOS, BELARUS, BELGIUM, BELIZE, BENIN, BERMUDA, BHUTAN,
BOLIVIA, BOSNIA-HERZEGOVINA, BOTSWANA, BRAZIL, BRITISH INDIAN OCEAN TERRITORY, BRUNEI, BULGARIA, BURKINA FASO, BURMA, BURUNDI,
CAMBODIA, CAMEROON, CANADA, CABO VERDE, CAYMAN ISLANDS, CENTRAL AFRICAN REPUBLIC, CHAD, CHILE, CHINA, COLOMBIA, COMOROS,
CONGO, DEMOCRATIC REPUBLIC OF THE, CONGO, REPUBLIC OF THE, COSTA RICA, COTE D`IVOIRE, CROATIA, CUBA, CYPRUS, CZECH REPUBLIC,
DENMARK, DJIBOUTI, DOMINICA, DOMINICAN REPUBLIC, ECUADOR, EGYPT, EL SALVADOR, EQUATORIAL GUINEA, ERITREA, ESTONIA, ESWATINI,
ETHIOPIA, FIJI, FINLAND, FRANCE, GABON, GAMBIA, THE, GEORGIA, GERMANY, GHANA, GIBRALTAR, GREECE, GRENADA, GUATEMALA, GUINEA,
GUINEA - BISSAU, GUYANA, HAITI, HEARD AND MCDONALD ISLANDS, HOLY SEE (VATICAN CITY), HONDURAS, HONG KONG SAR, HONG KONG, BRITISH
CONSULATE GENERAL, HUNGARY, ICELAND, INDIA, INDONESIA, IRAN, IRAQ, IRELAND, ISRAEL, ITALY, JAMAICA, JAPAN, JORDAN, KAZAKHSTAN, KENYA,
KIRIBATI, KOREA, DEMOCRATIC REPUBLIC OF (NORTH), KOREA, REPUBLIC OF (SOUTH), KOSOVO, KUWAIT, KYRGYZSTAN, LAOS, LATVIA, LEBANON,
LESOTHO, LIBERIA, LIBYA, LIECHTENSTEIN, LITHUANIA, LUXEMBOURG, MACAU, MADAGASCAR, MALAWI, MALAYSIA, MALDIVES, MALI, MALTA,
MARSHALL ISLANDS, MARTINIQUE, MAURITANIA, MAURITIUS, MEXICO, MICRONESIA, MOLDOVA, MONACO, MONGOLIA, MONTENEGRO, MONTSERRAT,
MOROCCO, MOZAMBIQUE, NAMIBIA, NAURU, NEPAL, NETHERLANDS, NEW ZEALAND, NICARAGUA, NIGER, NIGERIA, NORTH MACEDONIA, NORWAY,
OMAN, PAKISTAN, PALAU, PALESTINIAN AUTHORITY, PANAMA, PAPUA NEW GUINEA, PARAGUAY, PERU, PHILIPPINES, PITCAIRN ISLANDS, POLAND,
PORTUGAL, QATAR, ROMANIA, RUSSIA, RWANDA, SAMOA, SAN MARINO, SAO TOME AND PRINCIPE, SAUDI ARABIA, SENEGAL, SERBIA, SEYCHELLES,
SIERRA LEONE, SINGAPORE, SLOVAKIA, SLOVENIA, SOLOMON ISLANDS, SOMALIA, SOUTH AFRICA, SOUTH SUDAN, SPAIN, SRI LANKA, ST. HELENA, ST.
KITTS AND NEVIS, ST. LUCIA, ST. VINCENT AND THE GRENADINES, STATUS NEUTRAL TRAVEL DOCUMENT, SUDAN, SURINAME, SWEDEN, SWITZERLAND,
SYRIA, TAIWAN, TAJIKISTAN, TANZANIA, THAILAND, TIMOR-LESTE, TOGO, TONGA, TRINIDAD AND TOBAGO, TUNISIA, TURKEY, TURKMENISTAN, TURKS
AND CAICOS ISLANDS, TUVALU, UGANDA, UKRAINE, UNITED ARAB EMIRATES, UNITED KINGDOM, UNITED NATIONS LAISSEZ-PASSER, URUGUAY,
UZBEKISTAN, VANUATU, VENEZUELA, VIETNAM, VIRGIN ISLANDS, BRITISH, WALLIS AND FUTUNA ISLANDS, YEMEN, ZAMBIA, ZIMBABWE.

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Personal Information: Personal Information 2
Displayed for all applicants. Answered “Other Travel Document” for “Document Type”. Answered “Yes”
to “Do you hold or have you held any nationality other than the one you have indicated above?” and “Yes”
to “Have you owned any other passports within the past fifteen years that have not already been mentioned
above?”

Document Type Drop Down Values
Passport, Other Travel Document

Other Country/Region of Origin (Nationality) Drop Down Values
Same options as "Country/Authority that Issued Document" dropdown on page 9.

11

Address and Phone: Present and Previous Address Information
Displayed for all applicants. Answered “No” to all questions

12

Country/Region Drop Down Values
Select One, AFGHANISTAN, ALBANIA, ALGERIA, AMERICAN SAMOA, ANDORRA, ANGOLA, ANGUILLA, ANTIGUA AND BARBUDA, ARGENTINA, ARMENIA,
ARUBA, AUSTRALIA, AUSTRIA, AZERBAIJAN, BAHAMAS, BAHRAIN, BANGLADESH, BARBADOS, BELARUS, BELGIUM, BELIZE, BENIN, BERMUDA, BHUTAN,
BOLIVIA, BOSNIA-HERZEGOVINA, BOTSWANA, BRAZIL, BRITISH INDIAN OCEAN TERRITORY, BRUNEI, BULGARIA, BURKINA FASO, BURMA, BURUNDI,
CAMBODIA, CAMEROON, CANADA, CABO VERDE, CAYMAN ISLANDS, CENTRAL AFRICAN REPUBLIC, CHAD, CHILE, CHINA, COLOMBIA, COMOROS,
CONGO, DEMOCRATIC REPUBLIC OF THE, CONGO, REPUBLIC OF THE, COSTA RICA, COTE D`IVOIRE, CROATIA, CUBA, CYPRUS, CZECH REPUBLIC,
DENMARK, DJIBOUTI, DOMINICA, DOMINICAN REPUBLIC, ECUADOR, EGYPT, EL SALVADOR, EQUATORIAL GUINEA, ERITREA, ESTONIA, ESWATINI,
ETHIOPIA, FIJI, FINLAND, FRANCE, GABON, GAMBIA, THE, GEORGIA, GERMANY, GHANA, GIBRALTAR, GREECE, GRENADA, GUATEMALA, GUINEA,
GUINEA - BISSAU, GUYANA, HAITI, HEARD AND MCDONALD ISLANDS, HOLY SEE (VATICAN CITY), HONDURAS, HONG KONG SAR, HONG KONG, BRITISH
CONSULATE GENERAL, HUNGARY, ICELAND, INDIA, INDONESIA, IRAN, IRAQ, IRELAND, ISRAEL, ITALY, JAMAICA, JAPAN, JORDAN, KAZAKHSTAN, KENYA,
KIRIBATI, KOREA, DEMOCRATIC REPUBLIC OF (NORTH), KOREA, REPUBLIC OF (SOUTH), KOSOVO, KUWAIT, KYRGYZSTAN, LAOS, LATVIA, LEBANON,
LESOTHO, LIBERIA, LIBYA, LIECHTENSTEIN, LITHUANIA, LUXEMBOURG, MACAU, MADAGASCAR, MALAWI, MALAYSIA, MALDIVES, MALI, MALTA,
MARSHALL ISLANDS, MARTINIQUE, MAURITANIA, MAURITIUS, MEXICO, MICRONESIA, MOLDOVA, MONACO, MONGOLIA, MONTENEGRO, MONTSERRAT,
MOROCCO, MOZAMBIQUE, NAMIBIA, NAURU, NEPAL, NETHERLANDS, NEW ZEALAND, NICARAGUA, NIGER, NIGERIA, NORTH MACEDONIA, NORWAY,
OMAN, PAKISTAN, PALAU, PALESTINIAN AUTHORITY, PANAMA, PAPUA NEW GUINEA, PARAGUAY, PERU, PHILIPPINES, PITCAIRN ISLANDS, POLAND,
PORTUGAL, QATAR, ROMANIA, RUSSIA, RWANDA, SAMOA, SAN MARINO, SAO TOME AND PRINCIPE, SAUDI ARABIA, SENEGAL, SERBIA, SEYCHELLES,
SIERRA LEONE, SINGAPORE, SLOVAKIA, SLOVENIA, SOLOMON ISLANDS, SOMALIA, SOUTH AFRICA, SOUTH SUDAN, SPAIN, SRI LANKA, ST. HELENA, ST.
KITTS AND NEVIS, ST. LUCIA, ST. VINCENT AND THE GRENADINES, STATUS NEUTRAL TRAVEL DOCUMENT, SUDAN, SURINAME, SWEDEN, SWITZERLAND,
SYRIA, TAIWAN, TAJIKISTAN, TANZANIA, THAILAND, TIMOR-LESTE, TOGO, TONGA, TRINIDAD AND TOBAGO, TUNISIA, TURKEY, TURKMENISTAN, TURKS
AND CAICOS ISLANDS, TUVALU, UGANDA, UKRAINE, UNITED ARAB EMIRATES, UNITED KINGDOM, UNITED NATIONS LAISSEZ-PASSER, URUGUAY,
UZBEKISTAN, VANUATU, VENEZUELA, VIETNAM, VIRGIN ISLANDS, BRITISH, WALLIS AND FUTUNA ISLANDS, YEMEN, ZAMBIA, ZIMBABWE.

13

Address and Phone: Present and Previous Address Information
Displayed for all applicants. Answered “Yes” to all questions.

14

Started Living Here / Stopped Living Here Drop Down Values
Jan, Feb, Mar, Apr, May, Jun, Jul, Aug, Sep, Oct, Nov, Dec

Social Media Provider/Platform Drop Down Values
BlueSky, Discord, Douyin, Facebook, GroupMe, IMO, Instagram, Jodel, Kuaishou, LinkedIn, Myspace, Pinterest, QQ, QZone, Reddit, RedNotes (Xiaohongshu),
Skype, Snapchat, Telegram, Threads, TikTok, Truth Social, Tumblr, Twitch, VKontakte (VK), WeChat, Weibo Sina, Weibo Tencent, Weixin, X(Formally Twitter),
YouTube, None

15

Address and Phone: Mailing and Permanent
Displayed for all applicants who do not list “United States of America” as their Present Address
Country/Region. Displayed for all applicants. All questions answered “No” to all questions

16

Country/Region Drop Down Values
Select One, AFGHANISTAN, ALBANIA, ALGERIA, AMERICAN SAMOA, ANDORRA, ANGOLA, ANGUILLA, ANTIGUA AND BARBUDA, ARGENTINA, ARMENIA,
ARUBA, AUSTRALIA, AUSTRIA, AZERBAIJAN, BAHAMAS, BAHRAIN, BANGLADESH, BARBADOS, BELARUS, BELGIUM, BELIZE, BENIN, BERMUDA, BHUTAN,
BOLIVIA, BOSNIA-HERZEGOVINA, BOTSWANA, BRAZIL, BRITISH INDIAN OCEAN TERRITORY, BRUNEI, BULGARIA, BURKINA FASO, BURMA, BURUNDI,
CAMBODIA, CAMEROON, CANADA, CABO VERDE, CAYMAN ISLANDS, CENTRAL AFRICAN REPUBLIC, CHAD, CHILE, CHINA, COLOMBIA, COMOROS,
CONGO, DEMOCRATIC REPUBLIC OF THE, CONGO, REPUBLIC OF THE, COSTA RICA, COTE D`IVOIRE, CROATIA, CUBA, CYPRUS, CZECH REPUBLIC,
DENMARK, DJIBOUTI, DOMINICA, DOMINICAN REPUBLIC, ECUADOR, EGYPT, EL SALVADOR, EQUATORIAL GUINEA, ERITREA, ESTONIA, ESWATINI,
ETHIOPIA, FIJI, FINLAND, FRANCE, GABON, GAMBIA, THE, GEORGIA, GERMANY, GHANA, GIBRALTAR, GREECE, GRENADA, GUATEMALA, GUINEA,
GUINEA - BISSAU, GUYANA, HAITI, HEARD AND MCDONALD ISLANDS, HOLY SEE (VATICAN CITY), HONDURAS, HONG KONG SAR, HONG KONG, BRITISH
CONSULATE GENERAL, HUNGARY, ICELAND, INDIA, INDONESIA, IRAN, IRAQ, IRELAND, ISRAEL, ITALY, JAMAICA, JAPAN, JORDAN, KAZAKHSTAN, KENYA,
KIRIBATI, KOREA, DEMOCRATIC REPUBLIC OF (NORTH), KOREA, REPUBLIC OF (SOUTH), KOSOVO, KUWAIT, KYRGYZSTAN, LAOS, LATVIA, LEBANON,
LESOTHO, LIBERIA, LIBYA, LIECHTENSTEIN, LITHUANIA, LUXEMBOURG, MACAU, MADAGASCAR, MALAWI, MALAYSIA, MALDIVES, MALI, MALTA,
MARSHALL ISLANDS, MARTINIQUE, MAURITANIA, MAURITIUS, MEXICO, MICRONESIA, MOLDOVA, MONACO, MONGOLIA, MONTENEGRO, MONTSERRAT,
MOROCCO, MOZAMBIQUE, NAMIBIA, NAURU, NEPAL, NETHERLANDS, NEW ZEALAND, NICARAGUA, NIGER, NIGERIA, NORTH MACEDONIA, NORWAY,
OMAN, PAKISTAN, PALAU, PALESTINIAN AUTHORITY, PANAMA, PAPUA NEW GUINEA, PARAGUAY, PERU, PHILIPPINES, PITCAIRN ISLANDS, POLAND,
PORTUGAL, QATAR, ROMANIA, RUSSIA, RWANDA, SAMOA, SAN MARINO, SAO TOME AND PRINCIPE, SAUDI ARABIA, SENEGAL, SERBIA, SEYCHELLES,
SIERRA LEONE, SINGAPORE, SLOVAKIA, SLOVENIA, SOLOMON ISLANDS, SOMALIA, SOUTH AFRICA, SOUTH SUDAN, SPAIN, SRI LANKA, ST. HELENA, ST.
KITTS AND NEVIS, ST. LUCIA, ST. VINCENT AND THE GRENADINES, STATUS NEUTRAL TRAVEL DOCUMENT, SUDAN, SURINAME, SWEDEN, SWITZERLAND,
SYRIA, TAIWAN, TAJIKISTAN, TANZANIA, THAILAND, TIMOR-LESTE, TOGO, TONGA, TRINIDAD AND TOBAGO, TUNISIA, TURKEY, TURKMENISTAN, TURKS
AND CAICOS ISLANDS, TUVALU, UGANDA, UKRAINE, UNITED ARAB EMIRATES, UNITED KINGDOM, UNITED NATIONS LAISSEZ-PASSER, URUGUAY,
UZBEKISTAN, VANUATU, VENEZUELA, VIETNAM, VIRGIN ISLANDS, BRITISH, WALLIS AND FUTUNA ISLANDS, YEMEN, ZAMBIA, ZIMBABWE.

State Drop Down Values
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, NEBRASKA, NEVADA, NEW HAMPSHIRE, NEW JERSEY, NEW MEXICO, NEW YORK, NORTH
CAROLINA, NORTH DAKOTA, NORTHERN MARIANA ISLANDS, OHIO, OKLAHOMA, OREGON, PENNSYLVANIA, PUERTO RICO, RHODE ISLAND, SOUTH
CAROLINA, SOUTH DAKOTA, TENNESSEE, TEXAS, UTAH, VERMONT, VIRGIN ISLANDS, VIRGINIA, WASHINGTON, WEST VIRGINIA, WISCONSIN, WYOMING

17

Address and Phone: Mailing and Permanent
Displayed for all applicants who do not list “United States of America” as their Present Address
Country/Region. Answered “Yes” to all questions.

18

Family Information: Parents
Displayed for all applicants. Answered “No” to all questions

19

Country/Region of Birth Drop Down Values
Select One, AFGHANISTAN, ALBANIA, ALGERIA, AMERICAN SAMOA, ANDORRA, ANGOLA, ANGUILLA, ANTIGUA AND BARBUDA, ARGENTINA, ARMENIA,
ARUBA, AT SEA, AUSTRALIA, AUSTRIA, AZERBAIJAN, BAHAMAS, BAHRAIN, BANGLADESH, BARBADOS, BELARUS, BELGIUM, BELIZE, BENIN, BERMUDA,
BHUTAN, BOLIVIA, BONAIRE, BOSNIA-HERZEGOVINA, BOTSWANA, BRAZIL, BRITISH INDIAN OCEAN TERRITORY, BRUNEI, BULGARIA, BURKINA FASO,
BURMA, BURUNDI, CAMBODIA, CAMEROON, CANADA, CABO VERDE, CAYMAN ISLANDS, CENTRAL AFRICAN REPUBLIC, CHAD, CHILE, CHINA,
CHRISTMAS ISLAND, COCOS KEELING ISLANDS, COLOMBIA, COMOROS, CONGO, DEMOCRATIC REPUBLIC OF THE, CONGO, REPUBLIC OF THE, COOK
ISLANDS, COSTA RICA, COTE D`IVOIRE, CROATIA, CUBA, CURACAO, CYPRUS, CZECH REPUBLIC, DENMARK, DJIBOUTI, DOMINICA, DOMINICAN
REPUBLIC, ECUADOR, EGYPT, EL SALVADOR, EQUATORIAL GUINEA, ERITREA, ESTONIA, ESWATINI, ETHIOPIA, FALKLAND ISLANDS, FAROE ISLANDS, FIJI,
FINLAND, FRANCE, FRENCH GUIANA, FRENCH POLYNESIA, FRENCH SOUTHERN AND ANTARCTIC TERRITORIES, GABON, GAMBIA, THE, GAZA STRIP,
GEORGIA, GERMANY, GHANA, GIBRALTAR, GREECE, GREENLAND, GRENADA, GUADELOUPE, GUAM, GUATEMALA, GUINEA, GUINEA - BISSAU, GUYANA,
HAITI, HEARD AND MCDONALD ISLANDS, HOLY SEE (VATICAN CITY), HONDURAS, HONG KONG BNO, HONG KONG SAR, HOWLAND ISLAND, HUNGARY,
ICELAND, IN THE AIR, INDIA, INDONESIA, IRAN, IRAQ, IRELAND, ISRAEL, ITALY, JAMAICA, JAPAN, JERUSALEM, JORDAN, KAZAKHSTAN, KENYA, KIRIBATI,
KOREA, DEMOCRATIC REPUBLIC OF (NORTH), KOREA, REPUBLIC OF (SOUTH), KOSOVO, KUWAIT, KYRGYZSTAN, LAOS, LATVIA, LEBANON, LESOTHO,
LIBERIA, LIBYA, LIECHTENSTEIN, LITHUANIA, LUXEMBOURG, MACAU, MADAGASCAR, MALAWI, MALAYSIA, MALDEN ISLAND, MALDIVES, MALI, MALTA,
MARSHALL ISLANDS, MARTINIQUE, MAURITANIA, MAURITIUS, MAYOTTE, MEXICO - AGUASCALIENTES, MEXICO – BAJA CALIFORNIA NORTE, MEXICO BAJA CALIFORNIA SUR, MEXICO - CAMPECHE, MEXICO - CHIAPAS, MEXICO - CHIHUAHUA, MEXICO - COAHUILA, MEXICO - COLIMA, MEXICO - DISTRITO
FEDERAL, MEXICO - DURANGO, MEXICO - GUANAJUATO, MEXICO - GUERRERO, MEXICO - HIDALGO, MEXICO - JALISCO, MEXICO - MICHOACAN, MEXICO
- MORELOS, MEXICO - NAYARIT, MEXICO - NUEVO LEON, MEXICO - OAXACA, MEXICO - PUEBLA, MEXICO - QUERETARO, MEXICO - QUINTANA ROO,
MEXICO - SAN LUIS POTOSI, MEXICO - SINALOA, MEXICO - SONORA, MEXICO - STATE OF MEXICO, MEXICO - TABASCO, MEXICO - TAMAULIPAS, MEXICO TLAXCALA, MEXICO - VERACRUZ, MEXICO - YUCATAN, MEXICO - ZACATECAS, MICRONESIA, MIDWAY ISLANDS, MOLDOVA, MONACO, MONGOLIA,
MONTENEGRO, MONTSERRAT, MOROCCO, MOZAMBIQUE, NAMIBIA, NAURU, NEPAL, NETHERLANDS, NEW CALEDONIA, NEW ZEALAND, NICARAGUA,
NIGER, NIGERIA, NIUE, NORFOLK ISLAND, NORTH MACEDONIA, NORTH MARIANA ISLANDS, NORTHERN IRELAND, NORWAY, OMAN, PAKISTAN, PALAU,
PALMYRA ATOLL, PANAMA, PAPUA NEW GUINEA, PARAGUAY, PERU, PHILIPPINES, PITCAIRN ISLANDS, POLAND, PORTUGAL, PUERTO RICO, QATAR,
REUNION, ROMANIA, RUSSIA, RWANDA, SABA ISLAND, SAINT MARTIN, SAMOA, SAN MARINO, SAO TOME AND PRINCIPE, SAUDI ARABIA, SENEGAL,
SERBIA, SEYCHELLES, SIERRA LEONE, SINGAPORE, SINT MAARTEN, SLOVAKIA, SLOVENIA, SOLOMON ISLANDS, SOMALIA, SOUTH AFRICA, SOUTH
GEORGIA AND THE SOUTH SANDWICH ISLAND, SOUTH SUDAN, SPAIN, SRI LANKA, ST. BARTHELEMY, ST. EUSTATIUS, ST. HELENA, ST. KITTS AND NEVIS,
ST. LUCIA, ST. PIERRE AND MIQUELON, ST. VINCENT AND THE GRENADINES, SUDAN, SURINAME, SVALBARD, SWEDEN, SWITZERLAND, SYRIA, TAIWAN,
TAJIKISTAN, TANZANIA, THAILAND, TIMOR-LESTE, TOGO, TOKELAU, TONGA, TRINIDAD AND TOBAGO, TUNISIA, TURKEY, TURKMENISTAN, TURKS AND
CAICOS ISLANDS, TUVALU, UGANDA, UKRAINE, UNITED ARAB EMIRATES, UNITED KINGDOM, UNITED STATES OF AMERICA, URUGUAY, UZBEKISTAN,
VANUATU, VENEZUELA, VIETNAM, VIRGIN ISLANDS (U.S.), VIRGIN ISLANDS, BRITISH, WAKE ISLAND, WALLIS AND FUTUNA ISLANDS, WEST BANK,
WESTERN SAHARA, YEMEN, ZAMBIA, ZIMBABWE

20

Family Information: Parents
Displayed for all applicants. Answered “Yes” to all questions besides “No” for, “Is your mother's address
the same as your father's?”

21

22

Country/Region of Birth Drop Down Values
Select One, AFGHANISTAN, ALBANIA, ALGERIA, AMERICAN SAMOA, ANDORRA, ANGOLA, ANGUILLA, ANTIGUA AND BARBUDA, ARGENTINA, ARMENIA,
ARUBA, AT SEA, AUSTRALIA, AUSTRIA, AZERBAIJAN, BAHAMAS, BAHRAIN, BANGLADESH, BARBADOS, BELARUS, BELGIUM, BELIZE, BENIN, BERMUDA,
BHUTAN, BOLIVIA, BONAIRE, BOSNIA-HERZEGOVINA, BOTSWANA, BRAZIL, BRITISH INDIAN OCEAN TERRITORY, BRUNEI, BULGARIA, BURKINA FASO,
BURMA, BURUNDI, CAMBODIA, CAMEROON, CANADA, CABO VERDE, CAYMAN ISLANDS, CENTRAL AFRICAN REPUBLIC, CHAD, CHILE, CHINA,
CHRISTMAS ISLAND, COCOS KEELING ISLANDS, COLOMBIA, COMOROS, CONGO, DEMOCRATIC REPUBLIC OF THE, CONGO, REPUBLIC OF THE, COOK
ISLANDS, COSTA RICA, COTE D`IVOIRE, CROATIA, CUBA, CURACAO, CYPRUS, CZECH REPUBLIC, DENMARK, DJIBOUTI, DOMINICA, DOMINICAN
REPUBLIC, ECUADOR, EGYPT, EL SALVADOR, EQUATORIAL GUINEA, ERITREA, ESTONIA, ESWATINI, ETHIOPIA, FALKLAND ISLANDS, FAROE ISLANDS, FIJI,
FINLAND, FRANCE, FRENCH GUIANA, FRENCH POLYNESIA, FRENCH SOUTHERN AND ANTARCTIC TERRITORIES, GABON, GAMBIA, THE, GAZA STRIP,
GEORGIA, GERMANY, GHANA, GIBRALTAR, GREECE, GREENLAND, GRENADA, GUADELOUPE, GUAM, GUATEMALA, GUINEA, GUINEA - BISSAU, GUYANA,
HAITI, HEARD AND MCDONALD ISLANDS, HOLY SEE (VATICAN CITY), HONDURAS, HONG KONG BNO, HONG KONG SAR, HOWLAND ISLAND, HUNGARY,
ICELAND, IN THE AIR, INDIA, INDONESIA, IRAN, IRAQ, IRELAND, ISRAEL, ITALY, JAMAICA, JAPAN, JERUSALEM, JORDAN, KAZAKHSTAN, KENYA, KIRIBATI,
KOREA, DEMOCRATIC REPUBLIC OF (NORTH), KOREA, REPUBLIC OF (SOUTH), KOSOVO, KUWAIT, KYRGYZSTAN, LAOS, LATVIA, LEBANON, LESOTHO,
LIBERIA, LIBYA, LIECHTENSTEIN, LITHUANIA, LUXEMBOURG, MACAU, MADAGASCAR, MALAWI, MALAYSIA, MALDEN ISLAND, MALDIVES, MALI, MALTA,
MARSHALL ISLANDS, MARTINIQUE, MAURITANIA, MAURITIUS, MAYOTTE, MEXICO - AGUASCALIENTES, MEXICO – BAJA CALIFORNIA NORTE, MEXICO BAJA CALIFORNIA SUR, MEXICO - CAMPECHE, MEXICO - CHIAPAS, MEXICO - CHIHUAHUA, MEXICO - COAHUILA, MEXICO - COLIMA, MEXICO - DISTRITO
FEDERAL, MEXICO - DURANGO, MEXICO - GUANAJUATO, MEXICO - GUERRERO, MEXICO - HIDALGO, MEXICO - JALISCO, MEXICO - MICHOACAN, MEXICO
- MORELOS, MEXICO - NAYARIT, MEXICO - NUEVO LEON, MEXICO - OAXACA, MEXICO - PUEBLA, MEXICO - QUERETARO, MEXICO - QUINTANA ROO,
MEXICO - SAN LUIS POTOSI, MEXICO - SINALOA, MEXICO - SONORA, MEXICO - STATE OF MEXICO, MEXICO - TABASCO, MEXICO - TAMAULIPAS, MEXICO TLAXCALA, MEXICO - VERACRUZ, MEXICO - YUCATAN, MEXICO - ZACATECAS, MICRONESIA, MIDWAY ISLANDS, MOLDOVA, MONACO, MONGOLIA,
MONTENEGRO, MONTSERRAT, MOROCCO, MOZAMBIQUE, NAMIBIA, NAURU, NEPAL, NETHERLANDS, NEW CALEDONIA, NEW ZEALAND, NICARAGUA,
NIGER, NIGERIA, NIUE, NORFOLK ISLAND, NORTH MACEDONIA, NORTH MARIANA ISLANDS, NORTHERN IRELAND, NORWAY, OMAN, PAKISTAN, PALAU,
PALMYRA ATOLL, PANAMA, PAPUA NEW GUINEA, PARAGUAY, PERU, PHILIPPINES, PITCAIRN ISLANDS, POLAND, PORTUGAL, PUERTO RICO, QATAR,
REUNION, ROMANIA, RUSSIA, RWANDA, SABA ISLAND, SAINT MARTIN, SAMOA, SAN MARINO, SAO TOME AND PRINCIPE, SAUDI ARABIA, SENEGAL,
SERBIA, SEYCHELLES, SIERRA LEONE, SINGAPORE, SINT MAARTEN, SLOVAKIA, SLOVENIA, SOLOMON ISLANDS, SOMALIA, SOUTH AFRICA, SOUTH
GEORGIA AND THE SOUTH SANDWICH ISLAND, SOUTH SUDAN, SPAIN, SRI LANKA, ST. BARTHELEMY, ST. EUSTATIUS, ST. HELENA, ST. KITTS AND NEVIS,
ST. LUCIA, ST. PIERRE AND MIQUELON, ST. VINCENT AND THE GRENADINES, SUDAN, SURINAME, SVALBARD, SWEDEN, SWITZERLAND, SYRIA, TAIWAN,
TAJIKISTAN, TANZANIA, THAILAND, TIMOR-LESTE, TOGO, TOKELAU, TONGA, TRINIDAD AND TOBAGO, TUNISIA, TURKEY, TURKMENISTAN, TURKS AND
CAICOS ISLANDS, TUVALU, UGANDA, UKRAINE, UNITED ARAB EMIRATES, UNITED KINGDOM, UNITED STATES OF AMERICA, URUGUAY, UZBEKISTAN,
VANUATU, VENEZUELA, VIETNAM, VIRGIN ISLANDS (U.S.), VIRGIN ISLANDS, BRITISH, WAKE ISLAND, WALLIS AND FUTUNA ISLANDS, WEST BANK,
WESTERN SAHARA, YEMEN, ZAMBIA, ZIMBABWE

Country/Region Drop Down Values
Select One, AFGHANISTAN, ALBANIA, ALGERIA, AMERICAN SAMOA, ANDORRA, ANGOLA, ANGUILLA, ANTIGUA AND BARBUDA, ARGENTINA, ARMENIA,
ARUBA, AT SEA, AUSTRALIA, AUSTRIA, AZERBAIJAN, BAHAMAS, BAHRAIN, BANGLADESH, BARBADOS, BELARUS, BELGIUM, BELIZE, BENIN, BERMUDA,
BHUTAN, BOLIVIA, BONAIRE, BOSNIA-HERZEGOVINA, BOTSWANA, BRAZIL, BRITISH INDIAN OCEAN TERRITORY, BRUNEI, BULGARIA, BURKINA FASO,
BURMA, BURUNDI, CAMBODIA, CAMEROON, CANADA, CABO VERDE, CAYMAN ISLANDS, CENTRAL AFRICAN REPUBLIC, CHAD, CHILE, CHINA,
CHRISTMAS ISLAND, COCOS KEELING ISLANDS, COLOMBIA, COMOROS, CONGO, DEMOCRATIC REPUBLIC OF THE, CONGO, REPUBLIC OF THE, COOK
ISLANDS, COSTA RICA, COTE D`IVOIRE, CROATIA, CUBA, CURACAO, CYPRUS, CZECH REPUBLIC, DENMARK, DJIBOUTI, DOMINICA, DOMINICAN
REPUBLIC, ECUADOR, EGYPT, EL SALVADOR, EQUATORIAL GUINEA, ERITREA, ESTONIA, ESWATINI, ETHIOPIA, FALKLAND ISLANDS, FAROE ISLANDS, FIJI,
FINLAND, FRANCE, FRENCH GUIANA, FRENCH POLYNESIA, FRENCH SOUTHERN AND ANTARCTIC TERRITORIES, GABON, GAMBIA, THE, GAZA STRIP,
GEORGIA, GERMANY, GHANA, GIBRALTAR, GREECE, GREENLAND, GRENADA, GUADELOUPE, GUAM, GUATEMALA, GUINEA, GUINEA - BISSAU, GUYANA,
HAITI, HEARD AND MCDONALD ISLANDS, HOLY SEE (VATICAN CITY), HONDURAS, HONG KONG BNO, HONG KONG SAR, HOWLAND ISLAND, HUNGARY,
ICELAND, IN THE AIR, INDIA, INDONESIA, IRAN, IRAQ, IRELAND, ISRAEL, ITALY, JAMAICA, JAPAN, JERUSALEM, JORDAN, KAZAKHSTAN, KENYA, KIRIBATI,
KOREA, DEMOCRATIC REPUBLIC OF (NORTH), KOREA, REPUBLIC OF (SOUTH), KOSOVO, KUWAIT, KYRGYZSTAN, LAOS, LATVIA, LEBANON, LESOTHO,
LIBERIA, LIBYA, LIECHTENSTEIN, LITHUANIA, LUXEMBOURG, MACAU, MADAGASCAR, MALAWI, MALAYSIA, MALDEN ISLAND, MALDIVES, MALI, MALTA,
MARSHALL ISLANDS, MARTINIQUE, MAURITANIA, MAURITIUS, MAYOTTE, MEXICO - AGUASCALIENTES, MEXICO – BAJA CALIFORNIA NORTE, MEXICO BAJA CALIFORNIA SUR, MEXICO - CAMPECHE, MEXICO - CHIAPAS, MEXICO - CHIHUAHUA, MEXICO - COAHUILA, MEXICO - COLIMA, MEXICO - DISTRITO
FEDERAL, MEXICO - DURANGO, MEXICO - GUANAJUATO, MEXICO - GUERRERO, MEXICO - HIDALGO, MEXICO - JALISCO, MEXICO - MICHOACAN, MEXICO
- MORELOS, MEXICO - NAYARIT, MEXICO - NUEVO LEON, MEXICO - OAXACA, MEXICO - PUEBLA, MEXICO - QUERETARO, MEXICO - QUINTANA ROO,
MEXICO - SAN LUIS POTOSI, MEXICO - SINALOA, MEXICO - SONORA, MEXICO - STATE OF MEXICO, MEXICO - TABASCO, MEXICO - TAMAULIPAS, MEXICO TLAXCALA, MEXICO - VERACRUZ, MEXICO - YUCATAN, MEXICO - ZACATECAS, MICRONESIA, MIDWAY ISLANDS, MOLDOVA, MONACO, MONGOLIA,
MONTENEGRO, MONTSERRAT, MOROCCO, MOZAMBIQUE, NAMIBIA, NAURU, NEPAL, NETHERLANDS, NEW CALEDONIA, NEW ZEALAND, NICARAGUA,
NIGER, NIGERIA, NIUE, NORFOLK ISLAND, NORTH MACEDONIA, NORTH MARIANA ISLANDS, NORTHERN IRELAND, NORWAY, OMAN, PAKISTAN, PALAU,
PALMYRA ATOLL, PANAMA, PAPUA NEW GUINEA, PARAGUAY, PERU, PHILIPPINES, PITCAIRN ISLANDS, POLAND, PORTUGAL, PUERTO RICO, QATAR,
REUNION, ROMANIA, RUSSIA, RWANDA, SABA ISLAND, SAINT MARTIN, SAMOA, SAN MARINO, SAO TOME AND PRINCIPE, SAUDI ARABIA, SENEGAL,
SERBIA, SEYCHELLES, SIERRA LEONE, SINGAPORE, SINT MAARTEN, SLOVAKIA, SLOVENIA, SOLOMON ISLANDS, SOMALIA, SOUTH AFRICA, SOUTH
GEORGIA AND THE SOUTH SANDWICH ISLAND, SOUTH SUDAN, SPAIN, SRI LANKA, ST. BARTHELEMY, ST. EUSTATIUS, ST. HELENA, ST. KITTS AND NEVIS,
ST. LUCIA, ST. PIERRE AND MIQUELON, ST. VINCENT AND THE GRENADINES, SUDAN, SURINAME, SVALBARD, SWEDEN, SWITZERLAND, SYRIA, TAIWAN,
TAJIKISTAN, TANZANIA, THAILAND, TIMOR-LESTE, TOGO, TOKELAU, TONGA, TRINIDAD AND TOBAGO, TUNISIA, TURKEY, TURKMENISTAN, TURKS AND
CAICOS ISLANDS, TUVALU, UGANDA, UKRAINE, UNITED ARAB EMIRATES, UNITED KINGDOM, UNITED STATES OF AMERICA, URUGUAY, UZBEKISTAN,
VANUATU, VENEZUELA, VIETNAM, VIRGIN ISLANDS (U.S.), VIRGIN ISLANDS, BRITISH, WAKE ISLAND, WALLIS AND FUTUNA ISLANDS, WEST BANK,
WESTERN SAHARA, YEMEN, ZAMBIA, ZIMBABWE

23

Family Information: Parents
Displayed for all applicants. Answered” Yes” to all questions.

24

25

Family Information: Spouse or Civil/Domestic Partner
Displayed for applicants who indicate they are currently married or separated. Answered “No” to all
questions

26

Spouse’s Address Drop Down Values
Same as Present Address, Same as Intended U.S Address, Do Not Know, Other (Specify Address)

Occupation Drop Down Values
AGRICULTURE, ARTIST/PERFORMER, BUSINESS, COMMUNICATIONS, COMPUTER SCIENCE, CULINARY/FOOD SERVICES, DO NOT KNOW, EDUCATION,
ENGINEERING, GOVERNMENT, HOMEMAKER, LEGAL PROFESSION, MEDICAL/HEALTH, MILITARY, NATURAL SCIENCE, NOT EMPLOYED, PHYSICAL
SCIENCES, RELIGIOUS VOCATION, RESEARCH, RETIRED, SOCIAL SCIENCE, STUDENT, OTHER

Country/Region of Birth Drop Down Values
Select One, AFGHANISTAN, ALBANIA, ALGERIA, AMERICAN SAMOA, ANDORRA, ANGOLA, ANGUILLA, ANTIGUA AND BARBUDA, ARGENTINA, ARMENIA,
ARUBA, AT SEA, AUSTRALIA, AUSTRIA, AZERBAIJAN, BAHAMAS, BAHRAIN, BANGLADESH, BARBADOS, BELARUS, BELGIUM, BELIZE, BENIN, BERMUDA,
BHUTAN, BOLIVIA, BONAIRE, BOSNIA-HERZEGOVINA, BOTSWANA, BRAZIL, BRITISH INDIAN OCEAN TERRITORY, BRUNEI, BULGARIA, BURKINA FASO,
BURMA, BURUNDI, CAMBODIA, CAMEROON, CANADA, CABO VERDE, CAYMAN ISLANDS, CENTRAL AFRICAN REPUBLIC, CHAD, CHILE, CHINA,
CHRISTMAS ISLAND, COCOS KEELING ISLANDS, COLOMBIA, COMOROS, CONGO, DEMOCRATIC REPUBLIC OF THE, CONGO, REPUBLIC OF THE, COOK
ISLANDS, COSTA RICA, COTE D`IVOIRE, CROATIA, CUBA, CURACAO, CYPRUS, CZECH REPUBLIC, DENMARK, DJIBOUTI, DOMINICA, DOMINICAN
REPUBLIC, ECUADOR, EGYPT, EL SALVADOR, EQUATORIAL GUINEA, ERITREA, ESTONIA, ESWATINI, ETHIOPIA, FALKLAND ISLANDS, FAROE ISLANDS, FIJI,
FINLAND, FRANCE, FRENCH GUIANA, FRENCH POLYNESIA, FRENCH SOUTHERN AND ANTARCTIC TERRITORIES, GABON, GAMBIA, THE, GAZA STRIP,
GEORGIA, GERMANY, GHANA, GIBRALTAR, GREECE, GREENLAND, GRENADA, GUADELOUPE, GUAM, GUATEMALA, GUINEA, GUINEA - BISSAU, GUYANA,
HAITI, HEARD AND MCDONALD ISLANDS, HOLY SEE (VATICAN CITY), HONDURAS, HONG KONG BNO, HONG KONG SAR, HOWLAND ISLAND, HUNGARY,
ICELAND, IN THE AIR, INDIA, INDONESIA, IRAN, IRAQ, IRELAND, ISRAEL, ITALY, JAMAICA, JAPAN, JERUSALEM, JORDAN, KAZAKHSTAN, KENYA, KIRIBATI,
KOREA, DEMOCRATIC REPUBLIC OF (NORTH), KOREA, REPUBLIC OF (SOUTH), KOSOVO, KUWAIT, KYRGYZSTAN, LAOS, LATVIA, LEBANON, LESOTHO,
LIBERIA, LIBYA, LIECHTENSTEIN, LITHUANIA, LUXEMBOURG, MACAU, MADAGASCAR, MALAWI, MALAYSIA, MALDEN ISLAND, MALDIVES, MALI, MALTA,
MARSHALL ISLANDS, MARTINIQUE, MAURITANIA, MAURITIUS, MAYOTTE, MEXICO - AGUASCALIENTES, MEXICO – BAJA CALIFORNIA NORTE, MEXICO BAJA CALIFORNIA SUR, MEXICO - CAMPECHE, MEXICO - CHIAPAS, MEXICO - CHIHUAHUA, MEXICO - COAHUILA, MEXICO - COLIMA, MEXICO - DISTRITO
FEDERAL, MEXICO - DURANGO, MEXICO - GUANAJUATO, MEXICO - GUERRERO, MEXICO - HIDALGO, MEXICO - JALISCO, MEXICO - MICHOACAN, MEXICO
- MORELOS, MEXICO - NAYARIT, MEXICO - NUEVO LEON, MEXICO - OAXACA, MEXICO - PUEBLA, MEXICO - QUERETARO, MEXICO - QUINTANA ROO,
MEXICO - SAN LUIS POTOSI, MEXICO - SINALOA, MEXICO - SONORA, MEXICO - STATE OF MEXICO, MEXICO - TABASCO, MEXICO - TAMAULIPAS, MEXICO TLAXCALA, MEXICO - VERACRUZ, MEXICO - YUCATAN, MEXICO - ZACATECAS, MICRONESIA, MIDWAY ISLANDS, MOLDOVA, MONACO, MONGOLIA,
MONTENEGRO, MONTSERRAT, MOROCCO, MOZAMBIQUE, NAMIBIA, NAURU, NEPAL, NETHERLANDS, NEW CALEDONIA, NEW ZEALAND, NICARAGUA,
NIGER, NIGERIA, NIUE, NORFOLK ISLAND, NORTH MACEDONIA, NORTH MARIANA ISLANDS, NORTHERN IRELAND, NORWAY, OMAN, PAKISTAN, PALAU,
PALMYRA ATOLL, PANAMA, PAPUA NEW GUINEA, PARAGUAY, PERU, PHILIPPINES, PITCAIRN ISLANDS, POLAND, PORTUGAL, PUERTO RICO, QATAR,
REUNION, ROMANIA, RUSSIA, RWANDA, SABA ISLAND, SAINT MARTIN, SAMOA, SAN MARINO, SAO TOME AND PRINCIPE, SAUDI ARABIA, SENEGAL,
SERBIA, SEYCHELLES, SIERRA LEONE, SINGAPORE, SINT MAARTEN, SLOVAKIA, SLOVENIA, SOLOMON ISLANDS, SOMALIA, SOUTH AFRICA, SOUTH
GEORGIA AND THE SOUTH SANDWICH ISLAND, SOUTH SUDAN, SPAIN, SRI LANKA, ST. BARTHELEMY, ST. EUSTATIUS, ST. HELENA, ST. KITTS AND NEVIS,
ST. LUCIA, ST. PIERRE AND MIQUELON, ST. VINCENT AND THE GRENADINES, SUDAN, SURINAME, SVALBARD, SWEDEN, SWITZERLAND, SYRIA, TAIWAN,
TAJIKISTAN, TANZANIA, THAILAND, TIMOR-LESTE, TOGO, TOKELAU, TONGA, TRINIDAD AND TOBAGO, TUNISIA, TURKEY, TURKMENISTAN, TURKS AND
CAICOS ISLANDS, TUVALU, UGANDA, UKRAINE, UNITED ARAB EMIRATES, UNITED KINGDOM, UNITED STATES OF AMERICA, URUGUAY, UZBEKISTAN,
VANUATU, VENEZUELA, VIETNAM, VIRGIN ISLANDS (U.S.), VIRGIN ISLANDS, BRITISH, WAKE ISLAND, WALLIS AND FUTUNA ISLANDS, WEST BANK,
WESTERN SAHARA, YEMEN, ZAMBIA, ZIMBABWE

Country/Region Drop Down Values
Select One, AFGHANISTAN, ALBANIA, ALGERIA, AMERICAN SAMOA, ANDORRA, ANGOLA, ANGUILLA, ANTIGUA AND BARBUDA, ARGENTINA, ARMENIA,
ARUBA, AT SEA, AUSTRALIA, AUSTRIA, AZERBAIJAN, BAHAMAS, BAHRAIN, BANGLADESH, BARBADOS, BELARUS, BELGIUM, BELIZE, BENIN, BERMUDA,
BHUTAN, BOLIVIA, BONAIRE, BOSNIA-HERZEGOVINA, BOTSWANA, BRAZIL, BRITISH INDIAN OCEAN TERRITORY, BRUNEI, BULGARIA, BURKINA FASO,
BURMA, BURUNDI, CAMBODIA, CAMEROON, CANADA, CABO VERDE, CAYMAN ISLANDS, CENTRAL AFRICAN REPUBLIC, CHAD, CHILE, CHINA,
CHRISTMAS ISLAND, COCOS KEELING ISLANDS, COLOMBIA, COMOROS, CONGO, DEMOCRATIC REPUBLIC OF THE, CONGO, REPUBLIC OF THE, COOK
ISLANDS, COSTA RICA, COTE D`IVOIRE, CROATIA, CUBA, CURACAO, CYPRUS, CZECH REPUBLIC, DENMARK, DJIBOUTI, DOMINICA, DOMINICAN
REPUBLIC, ECUADOR, EGYPT, EL SALVADOR, EQUATORIAL GUINEA, ERITREA, ESTONIA, ESWATINI, ETHIOPIA, FALKLAND ISLANDS, FAROE ISLANDS, FIJI,
FINLAND, FRANCE, FRENCH GUIANA, FRENCH POLYNESIA, FRENCH SOUTHERN AND ANTARCTIC TERRITORIES, GABON, GAMBIA, THE, GAZA STRIP,
GEORGIA, GERMANY, GHANA, GIBRALTAR, GREECE, GREENLAND, GRENADA, GUADELOUPE, GUAM, GUATEMALA, GUINEA, GUINEA - BISSAU, GUYANA,
HAITI, HEARD AND MCDONALD ISLANDS, HOLY SEE (VATICAN CITY), HONDURAS, HONG KONG BNO, HONG KONG SAR, HOWLAND ISLAND, HUNGARY,
ICELAND, IN THE AIR, INDIA, INDONESIA, IRAN, IRAQ, IRELAND, ISRAEL, ITALY, JAMAICA, JAPAN, JERUSALEM, JORDAN, KAZAKHSTAN, KENYA, KIRIBATI,
KOREA, DEMOCRATIC REPUBLIC OF (NORTH), KOREA, REPUBLIC OF (SOUTH), KOSOVO, KUWAIT, KYRGYZSTAN, LAOS, LATVIA, LEBANON, LESOTHO,
LIBERIA, LIBYA, LIECHTENSTEIN, LITHUANIA, LUXEMBOURG, MACAU, MADAGASCAR, MALAWI, MALAYSIA, MALDEN ISLAND, MALDIVES, MALI, MALTA,
MARSHALL ISLANDS, MARTINIQUE, MAURITANIA, MAURITIUS, MAYOTTE, MEXICO - AGUASCALIENTES, MEXICO – BAJA CALIFORNIA NORTE, MEXICO BAJA CALIFORNIA SUR, MEXICO - CAMPECHE, MEXICO - CHIAPAS, MEXICO - CHIHUAHUA, MEXICO - COAHUILA, MEXICO - COLIMA, MEXICO - DISTRITO
FEDERAL, MEXICO - DURANGO, MEXICO - GUANAJUATO, MEXICO - GUERRERO, MEXICO - HIDALGO, MEXICO - JALISCO, MEXICO - MICHOACAN, MEXICO
- MORELOS, MEXICO - NAYARIT, MEXICO - NUEVO LEON, MEXICO - OAXACA, MEXICO - PUEBLA, MEXICO - QUERETARO, MEXICO - QUINTANA ROO,
MEXICO - SAN LUIS POTOSI, MEXICO - SINALOA, MEXICO - SONORA, MEXICO - STATE OF MEXICO, MEXICO - TABASCO, MEXICO - TAMAULIPAS, MEXICO TLAXCALA, MEXICO - VERACRUZ, MEXICO - YUCATAN, MEXICO - ZACATECAS, MICRONESIA, MIDWAY ISLANDS, MOLDOVA, MONACO, MONGOLIA,
MONTENEGRO, MONTSERRAT, MOROCCO, MOZAMBIQUE, NAMIBIA, NAURU, NEPAL, NETHERLANDS, NEW CALEDONIA, NEW ZEALAND, NICARAGUA,
NIGER, NIGERIA, NIUE, NORFOLK ISLAND, NORTH MACEDONIA, NORTH MARIANA ISLANDS, NORTHERN IRELAND, NORWAY, OMAN, PAKISTAN, PALAU,
PALMYRA ATOLL, PANAMA, PAPUA NEW GUINEA, PARAGUAY, PERU, PHILIPPINES, PITCAIRN ISLANDS, POLAND, PORTUGAL, PUERTO RICO, QATAR,
REUNION, ROMANIA, RUSSIA, RWANDA, SABA ISLAND, SAINT MARTIN, SAMOA, SAN MARINO, SAO TOME AND PRINCIPE, SAUDI ARABIA, SENEGAL,
SERBIA, SEYCHELLES, SIERRA LEONE, SINGAPORE, SINT MAARTEN, SLOVAKIA, SLOVENIA, SOLOMON ISLANDS, SOMALIA, SOUTH AFRICA, SOUTH
GEORGIA AND THE SOUTH SANDWICH ISLAND, SOUTH SUDAN, SPAIN, SRI LANKA, ST. BARTHELEMY, ST. EUSTATIUS, ST. HELENA, ST. KITTS AND NEVIS,
ST. LUCIA, ST. PIERRE AND MIQUELON, ST. VINCENT AND THE GRENADINES, SUDAN, SURINAME, SVALBARD, SWEDEN, SWITZERLAND, SYRIA, TAIWAN,
TAJIKISTAN, TANZANIA, THAILAND, TIMOR-LESTE, TOGO, TOKELAU, TONGA, TRINIDAD AND TOBAGO, TUNISIA, TURKEY, TURKMENISTAN, TURKS AND
CAICOS ISLANDS, TUVALU, UGANDA, UKRAINE, UNITED ARAB EMIRATES, UNITED KINGDOM, UNITED STATES OF AMERICA, URUGUAY, UZBEKISTAN,
VANUATU, VENEZUELA, VIETNAM, VIRGIN ISLANDS (U.S.), VIRGIN ISLANDS, BRITISH, WAKE ISLAND, WALLIS AND FUTUNA ISLANDS, WEST BANK,
WESTERN SAHARA, YEMEN, ZAMBIA, ZIMBABWE

Nationality Drop Down Values
Same options as "Country/Authority that Issued Document" dropdown on page 9.

27

Family Information: Spouse or Civil/Domestic Partner
Displayed for applicants who indicate they are currently married or separated. Answered “No” to “Is your
spouse immigrating to the U.S. with you?” and “Yes” to “Is your spouse immigrating to the U.S. at a later
date to join you?”

28

Family Information: Spouse or Civil/Domestic Partner
Displayed for applicants who indicate they are currently married or separated. Answered “Yes” to “Is your
spouse immigrating to the U.S. with you?”

29

Family Information: Spouse or Civil/Domestic Partner
Displayed for applicants who indicate they are currently married or separated. Answered “OTHER
(SPECIFY ADDRESS)” for Spouse’s Address

30

Family Information: Previous Spouse or Civil/Domestic Partner
Displayed for all applicants. Answered “No” to “Do you have any previous
spouses?”

31

Family Information: Previous Spouse or Civil/Domestic Partner
Displayed for all applicants. Answered “Yes” to “Do you have any previous
spouses?”

“How was your marriage terminated?” Drop Down Values
Annulment, Death, Divorce, Other

“Country/Region where marriage was terminated” Drop Down Values
Select One, AFGHANISTAN, ALBANIA, ALGERIA, AMERICAN SAMOA, ANDORRA, ANGOLA, ANGUILLA, ANTIGUA AND BARBUDA, ARGENTINA, ARMENIA,
ARUBA, AUSTRALIA, AUSTRIA, AZERBAIJAN, BAHAMAS, BAHRAIN, BANGLADESH, BARBADOS, BELARUS, BELGIUM, BELIZE, BENIN, BERMUDA, BHUTAN,
BOLIVIA, BOSNIA-HERZEGOVINA, BOTSWANA, BRAZIL, BRITISH INDIAN OCEAN TERRITORY, BRUNEI, BULGARIA, BURKINA FASO, BURMA, BURUNDI,
CAMBODIA, CAMEROON, CANADA, CABO VERDE, CAYMAN ISLANDS, CENTRAL AFRICAN REPUBLIC, CHAD, CHILE, CHINA, COLOMBIA, COMOROS,
CONGO, DEMOCRATIC REPUBLIC OF THE, CONGO, REPUBLIC OF THE, COSTA RICA, COTE D`IVOIRE, CROATIA, CUBA, CYPRUS, CZECH REPUBLIC,
DENMARK, DJIBOUTI, DOMINICA, DOMINICAN REPUBLIC, ECUADOR, EGYPT, EL SALVADOR, EQUATORIAL GUINEA, ERITREA, ESTONIA, ESWATINI,
ETHIOPIA, FIJI, FINLAND, FRANCE, GABON, GAMBIA, THE, GEORGIA, GERMANY, GHANA, GIBRALTAR, GREECE, GRENADA, GUATEMALA, GUINEA,
GUINEA - BISSAU, GUYANA, HAITI, HEARD AND MCDONALD ISLANDS, HOLY SEE (VATICAN CITY), HONDURAS, HONG KONG SAR, HONG KONG, BRITISH
CONSULATE GENERAL, HUNGARY, ICELAND, INDIA, INDONESIA, IRAN, IRAQ, IRELAND, ISRAEL, ITALY, JAMAICA, JAPAN, JORDAN, KAZAKHSTAN, KENYA,
KIRIBATI, KOREA, DEMOCRATIC REPUBLIC OF (NORTH), KOREA, REPUBLIC OF (SOUTH), KOSOVO, KUWAIT, KYRGYZSTAN, LAOS, LATVIA, LEBANON,
LESOTHO, LIBERIA, LIBYA, LIECHTENSTEIN, LITHUANIA, LUXEMBOURG, MACAU, MADAGASCAR, MALAWI, MALAYSIA, MALDIVES, MALI, MALTA,
MARSHALL ISLANDS, MARTINIQUE, MAURITANIA, MAURITIUS, MEXICO, MICRONESIA, MOLDOVA, MONACO, MONGOLIA, MONTENEGRO, MONTSERRAT,
MOROCCO, MOZAMBIQUE, NAMIBIA, NAURU, NEPAL, NETHERLANDS, NEW ZEALAND, NICARAGUA, NIGER, NIGERIA, NORTH MACEDONIA, NORWAY,
OMAN, PAKISTAN, PALAU, PALESTINIAN AUTHORITY, PANAMA, PAPUA NEW GUINEA, PARAGUAY, PERU, PHILIPPINES, PITCAIRN ISLANDS, POLAND,
PORTUGAL, QATAR, ROMANIA, RUSSIA, RWANDA, SAMOA, SAN MARINO, SAO TOME AND PRINCIPE, SAUDI ARABIA, SENEGAL, SERBIA, SEYCHELLES,
SIERRA LEONE, SINGAPORE, SLOVAKIA, SLOVENIA, SOLOMON ISLANDS, SOMALIA, SOUTH AFRICA, SOUTH SUDAN, SPAIN, SRI LANKA, ST. HELENA, ST.
KITTS AND NEVIS, ST. LUCIA, ST. VINCENT AND THE GRENADINES, STATUS NEUTRAL TRAVEL DOCUMENT, SUDAN, SURINAME, SWEDEN, SWITZERLAND,
SYRIA, TAIWAN, TAJIKISTAN, TANZANIA, THAILAND, TIMOR-LESTE, TOGO, TONGA, TRINIDAD AND TOBAGO, TUNISIA, TURKEY, TURKMENISTAN, TURKS
AND CAICOS ISLANDS, TUVALU, UGANDA, UKRAINE, UNITED ARAB EMIRATES, UNITED KINGDOM, UNITED NATIONS LAISSEZ-PASSER, URUGUAY,
UZBEKISTAN, VANUATU, VENEZUELA, VIETNAM, VIRGIN ISLANDS, BRITISH, WALLIS AND FUTUNA ISLANDS, YEMEN, ZAMBIA, ZIMBABWE.

Nationality Drop Down Values
Same options as "Country/Authority that Issued Document" dropdown on page 9.

32

Family Information: Children
NOTE: The Immigration and Nationality Act (INA) does not allow derivative status to family members
of immediate relatives. For example, IR1, CR1, IR2, CR2 and IR5 classifications are immediate relative
visa categories. The petitioner must file separate immediate relative petitions for the spouse, each natural
child, adopted child, stepchild and each parent.
Displayed for all applicants. Answered “No” to “Do you have any children?”

33

Family Information: Children
Displayed for all applicants. Answered ‘Yes’ to the question ‘Do you have any children?’. Answered “Yes”
to “Do you have any children?”, “No” to “Does this child live with you?”, “No” to “Is this child immigrating
to the U.S. with you?”, and “No” to “Is this child immigrating to the U.S. at a later date to join you?”

34

Country/Region of Birth Drop Down Values
Select One, AFGHANISTAN, ALBANIA, ALGERIA, AMERICAN SAMOA, ANDORRA, ANGOLA, ANGUILLA, ANTIGUA AND BARBUDA, ARGENTINA, ARMENIA,
ARUBA, AT SEA, AUSTRALIA, AUSTRIA, AZERBAIJAN, BAHAMAS, BAHRAIN, BANGLADESH, BARBADOS, BELARUS, BELGIUM, BELIZE, BENIN, BERMUDA,
BHUTAN, BOLIVIA, BONAIRE, BOSNIA-HERZEGOVINA, BOTSWANA, BRAZIL, BRITISH INDIAN OCEAN TERRITORY, BRUNEI, BULGARIA, BURKINA FASO,
BURMA, BURUNDI, CAMBODIA, CAMEROON, CANADA, CABO VERDE, CAYMAN ISLANDS, CENTRAL AFRICAN REPUBLIC, CHAD, CHILE, CHINA,
CHRISTMAS ISLAND, COCOS KEELING ISLANDS, COLOMBIA, COMOROS, CONGO, DEMOCRATIC REPUBLIC OF THE, CONGO, REPUBLIC OF THE, COOK
ISLANDS, COSTA RICA, COTE D`IVOIRE, CROATIA, CUBA, CURACAO, CYPRUS, CZECH REPUBLIC, DENMARK, DJIBOUTI, DOMINICA, DOMINICAN
REPUBLIC, ECUADOR, EGYPT, EL SALVADOR, EQUATORIAL GUINEA, ERITREA, ESTONIA, ESWATINI, ETHIOPIA, FALKLAND ISLANDS, FAROE ISLANDS, FIJI,
FINLAND, FRANCE, FRENCH GUIANA, FRENCH POLYNESIA, FRENCH SOUTHERN AND ANTARCTIC TERRITORIES, GABON, GAMBIA, THE, GAZA STRIP,
GEORGIA, GERMANY, GHANA, GIBRALTAR, GREECE, GREENLAND, GRENADA, GUADELOUPE, GUAM, GUATEMALA, GUINEA, GUINEA - BISSAU, GUYANA,
HAITI, HEARD AND MCDONALD ISLANDS, HOLY SEE (VATICAN CITY), HONDURAS, HONG KONG BNO, HONG KONG SAR, HOWLAND ISLAND, HUNGARY,
ICELAND, IN THE AIR, INDIA, INDONESIA, IRAN, IRAQ, IRELAND, ISRAEL, ITALY, JAMAICA, JAPAN, JERUSALEM, JORDAN, KAZAKHSTAN, KENYA, KIRIBATI,
KOREA, DEMOCRATIC REPUBLIC OF (NORTH), KOREA, REPUBLIC OF (SOUTH), KOSOVO, KUWAIT, KYRGYZSTAN, LAOS, LATVIA, LEBANON, LESOTHO,
LIBERIA, LIBYA, LIECHTENSTEIN, LITHUANIA, LUXEMBOURG, MACAU, MADAGASCAR, MALAWI, MALAYSIA, MALDEN ISLAND, MALDIVES, MALI, MALTA,
MARSHALL ISLANDS, MARTINIQUE, MAURITANIA, MAURITIUS, MAYOTTE, MEXICO - AGUASCALIENTES, MEXICO – BAJA CALIFORNIA NORTE, MEXICO BAJA CALIFORNIA SUR, MEXICO - CAMPECHE, MEXICO - CHIAPAS, MEXICO - CHIHUAHUA, MEXICO - COAHUILA, MEXICO - COLIMA, MEXICO - DISTRITO
FEDERAL, MEXICO - DURANGO, MEXICO - GUANAJUATO, MEXICO - GUERRERO, MEXICO - HIDALGO, MEXICO - JALISCO, MEXICO - MICHOACAN, MEXICO
- MORELOS, MEXICO - NAYARIT, MEXICO - NUEVO LEON, MEXICO - OAXACA, MEXICO - PUEBLA, MEXICO - QUERETARO, MEXICO - QUINTANA ROO,
MEXICO - SAN LUIS POTOSI, MEXICO - SINALOA, MEXICO - SONORA, MEXICO - STATE OF MEXICO, MEXICO - TABASCO, MEXICO - TAMAULIPAS, MEXICO TLAXCALA, MEXICO - VERACRUZ, MEXICO - YUCATAN, MEXICO - ZACATECAS, MICRONESIA, MIDWAY ISLANDS, MOLDOVA, MONACO, MONGOLIA,
MONTENEGRO, MONTSERRAT, MOROCCO, MOZAMBIQUE, NAMIBIA, NAURU, NEPAL, NETHERLANDS, NEW CALEDONIA, NEW ZEALAND, NICARAGUA,
NIGER, NIGERIA, NIUE, NORFOLK ISLAND, NORTH MACEDONIA, NORTH MARIANA ISLANDS, NORTHERN IRELAND, NORWAY, OMAN, PAKISTAN, PALAU,
PALMYRA ATOLL, PANAMA, PAPUA NEW GUINEA, PARAGUAY, PERU, PHILIPPINES, PITCAIRN ISLANDS, POLAND, PORTUGAL, PUERTO RICO, QATAR,
REUNION, ROMANIA, RUSSIA, RWANDA, SABA ISLAND, SAINT MARTIN, SAMOA, SAN MARINO, SAO TOME AND PRINCIPE, SAUDI ARABIA, SENEGAL,
SERBIA, SEYCHELLES, SIERRA LEONE, SINGAPORE, SINT MAARTEN, SLOVAKIA, SLOVENIA, SOLOMON ISLANDS, SOMALIA, SOUTH AFRICA, SOUTH
GEORGIA AND THE SOUTH SANDWICH ISLAND, SOUTH SUDAN, SPAIN, SRI LANKA, ST. BARTHELEMY, ST. EUSTATIUS, ST. HELENA, ST. KITTS AND NEVIS,
ST. LUCIA, ST. PIERRE AND MIQUELON, ST. VINCENT AND THE GRENADINES, SUDAN, SURINAME, SVALBARD, SWEDEN, SWITZERLAND, SYRIA, TAIWAN,
TAJIKISTAN, TANZANIA, THAILAND, TIMOR-LESTE, TOGO, TOKELAU, TONGA, TRINIDAD AND TOBAGO, TUNISIA, TURKEY, TURKMENISTAN, TURKS AND
CAICOS ISLANDS, TUVALU, UGANDA, UKRAINE, UNITED ARAB EMIRATES, UNITED KINGDOM, UNITED STATES OF AMERICA, URUGUAY, UZBEKISTAN,
VANUATU, VENEZUELA, VIETNAM, VIRGIN ISLANDS (U.S.), VIRGIN ISLANDS, BRITISH, WAKE ISLAND, WALLIS AND FUTUNA ISLANDS, WEST BANK,
WESTERN SAHARA, YEMEN, ZAMBIA, ZIMBABWE

Country/Region Drop Down Values
Select One, AFGHANISTAN, ALBANIA, ALGERIA, AMERICAN SAMOA, ANDORRA, ANGOLA, ANGUILLA, ANTIGUA AND BARBUDA, ARGENTINA, ARMENIA,
ARUBA, AUSTRALIA, AUSTRIA, AZERBAIJAN, BAHAMAS, BAHRAIN, BANGLADESH, BARBADOS, BELARUS, BELGIUM, BELIZE, BENIN, BERMUDA, BHUTAN,
BOLIVIA, BOSNIA-HERZEGOVINA, BOTSWANA, BRAZIL, BRITISH INDIAN OCEAN TERRITORY, BRUNEI, BULGARIA, BURKINA FASO, BURMA, BURUNDI,
CAMBODIA, CAMEROON, CANADA, CABO VERDE, CAYMAN ISLANDS, CENTRAL AFRICAN REPUBLIC, CHAD, CHILE, CHINA, COLOMBIA, COMOROS,
CONGO, DEMOCRATIC REPUBLIC OF THE, CONGO, REPUBLIC OF THE, COSTA RICA, COTE D`IVOIRE, CROATIA, CUBA, CYPRUS, CZECH REPUBLIC,
DENMARK, DJIBOUTI, DOMINICA, DOMINICAN REPUBLIC, ECUADOR, EGYPT, EL SALVADOR, EQUATORIAL GUINEA, ERITREA, ESTONIA, ESWATINI,
ETHIOPIA, FIJI, FINLAND, FRANCE, GABON, GAMBIA, THE, GEORGIA, GERMANY, GHANA, GIBRALTAR, GREECE, GRENADA, GUATEMALA, GUINEA,
GUINEA - BISSAU, GUYANA, HAITI, HEARD AND MCDONALD ISLANDS, HOLY SEE (VATICAN CITY), HONDURAS, HONG KONG SAR, HONG KONG, BRITISH
CONSULATE GENERAL, HUNGARY, ICELAND, INDIA, INDONESIA, IRAN, IRAQ, IRELAND, ISRAEL, ITALY, JAMAICA, JAPAN, JORDAN, KAZAKHSTAN, KENYA,
KIRIBATI, KOREA, DEMOCRATIC REPUBLIC OF (NORTH), KOREA, REPUBLIC OF (SOUTH), KOSOVO, KUWAIT, KYRGYZSTAN, LAOS, LATVIA, LEBANON,
LESOTHO, LIBERIA, LIBYA, LIECHTENSTEIN, LITHUANIA, LUXEMBOURG, MACAU, MADAGASCAR, MALAWI, MALAYSIA, MALDIVES, MALI, MALTA,
MARSHALL ISLANDS, MARTINIQUE, MAURITANIA, MAURITIUS, MEXICO, MICRONESIA, MOLDOVA, MONACO, MONGOLIA, MONTENEGRO, MONTSERRAT,
MOROCCO, MOZAMBIQUE, NAMIBIA, NAURU, NEPAL, NETHERLANDS, NEW ZEALAND, NICARAGUA, NIGER, NIGERIA, NORTH MACEDONIA, NORWAY,
OMAN, PAKISTAN, PALAU, PALESTINIAN AUTHORITY, PANAMA, PAPUA NEW GUINEA, PARAGUAY, PERU, PHILIPPINES, PITCAIRN ISLANDS, POLAND,
PORTUGAL, QATAR, ROMANIA, RUSSIA, RWANDA, SAMOA, SAN MARINO, SAO TOME AND PRINCIPE, SAUDI ARABIA, SENEGAL, SERBIA, SEYCHELLES,
SIERRA LEONE, SINGAPORE, SLOVAKIA, SLOVENIA, SOLOMON ISLANDS, SOMALIA, SOUTH AFRICA, SOUTH SUDAN, SPAIN, SRI LANKA, ST. HELENA, ST.
KITTS AND NEVIS, ST. LUCIA, ST. VINCENT AND THE GRENADINES, STATUS NEUTRAL TRAVEL DOCUMENT, SUDAN, SURINAME, SWEDEN, SWITZERLAND,
SYRIA, TAIWAN, TAJIKISTAN, TANZANIA, THAILAND, TIMOR-LESTE, TOGO, TONGA, TRINIDAD AND TOBAGO, TUNISIA, TURKEY, TURKMENISTAN, TURKS
AND CAICOS ISLANDS, TUVALU, UGANDA, UKRAINE, UNITED ARAB EMIRATES, UNITED KINGDOM, UNITED NATIONS LAISSEZ-PASSER, URUGUAY,
UZBEKISTAN, VANUATU, VENEZUELA, VIETNAM, VIRGIN ISLANDS, BRITISH, WALLIS AND FUTUNA ISLANDS, YEMEN, ZAMBIA, ZIMBABWE.

Other Country/Region of Origin (Nationality) Drop Down Values
Same options as "Country/Authority that Issued Document" dropdown on page 9.

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Family Information: Children
Displayed for all applicants. Answered “Yes” to “Do you have any children?”, “No” to “Does this child live
with you?” “No” to “Is this child immigrating to the U.S. with you?”, and “Yes” to “Is this child immigrating
to the U.S. at a later date to join you?”

36

Family Information: Children
Displayed for all applicants. Answered “Yes” to “Do you have any children?”, “No” to “Does this child live
with you?”, and “Yes” to “Is this child immigrating to the U.S. with you?”

37

Family Information: Children
Displayed for all applicants. Answered “Yes” to “Do you have any children?”, “Yes” to “Does this child live
with you?”, and “Yes” to “Is this child immigrating to the U.S. with you?”

38

Family Information: Siblings
Displayed for all applicants. Answered “No” for all questions.

Family Information: Siblings
Displayed for all applicants. Answered “Yes” for all questions.

Nationality Drop Down Values
Same options as "Country/Authority that Issued Document" dropdown on page 9.

Previous U.S. Travel
Displayed for all applicants. Answered “No” for all questions.

39

Previous U.S. Travel
Displayed for all applicants. Answered “Yes” for all questions.

Length of Stay (Duration) Drop Down Values
Day(s), Week(s), Month(s), Year(s)

40

Visa Classification Drop Down Values
Select one, AMBASSADOR OR PUBLIC MINISTER (A1), CHILD OF AN A1 (A1), CAREER DIPLOMAT/CONSULAR OFFICER (A1), SPOUSE OF AN A1 (A1), CHILD
OF AN A2 (A2), FOREIGN OFFICIAL/EMPLOYEE (A2), SPOUSE OF AN A2 (A2), CHILD OF AN A3 (A3), PERSONAL EMP. OF AN A1 OR A2 (A3), SPOUSE OF AN
A3 (A3), BUSINESS & TOURISM (TEMPORARY VISITOR) (B1/B2), BUSINESS/CONFERENCE (B1), TOURISM/MEDICAL TREATMENT (B2), BORDER CROSSING
CARD (MEXICO ONLY) (BCC), CREWMEMBER IN TRANSIT (C1/D), TRANSIT (C1), TRANSIT TO U.N. HEADQUARTERS (C2), CHILD OF A C3 (C3), PERSONAL
EMP. OF A C3 (C3), FOREIGN OFFICIAL IN TRANSIT (C3), SPOUSE OF A C3 (C3), NONCITIZEN IN TRANSIT TO LIGHTERING OPERATION (C4), LIGHTERING
CREW MEMBER IN TRANSIT (C4/D3), CNMI TEMPORARY WORKER (CW1), CHILD OF CW1 (CW2), SPOUSE OF CW1 (CW2), CREWMEMBER (D),
LIGHTERING CREW MEMBER (D3), CHILD OF AN E1 (E1), EXECUTIVE/MGR/ESSENTIAL EMP (E1), SPOUSE OF AN E1 (E1), TREATY TRADER (E1), CHILD OF
AN E2 (E2), EXECUTIVE/MGR/ESSENTIAL EMP (E2), SPOUSE OF AN E2 (E2), TREATY INVESTOR (E2), CNMI LONG TERM INVESTOR (E2C), AUSTRALIAN IN
SPEC. OCCUPATION (E3), CHILD OF AN E3 (E3D), SPOUSE OF AN E3 (E3D), RETURNING AUSTRALIAN IN A SPEC. OCCUPATION (E3R), STUDENT (F1),
CHILD OF AN F1 (F2), SPOUSE OF AN F1 (F2), COMMUTER STUDENT (F3), CHILD OF A G1 (G1), PRINCIPAL REPRESENTATIVE (G1), SPOUSE OF A G1 (G1),
STAFF OF PRINCIPAL REPRESENTATIVE (G1), CHILD OF A G2 (G2), REPRESENTATIVE (G2), SPOUSE OF A G2 (G2), CHILD OF A G3 (G3), NONRECOGNIZED/-MEMBER COUNTRY REP(G3), SPOUSE OF A G3 (G3), CHILD OF AN G4 (G4), INTERNATIONAL ORG. EMPLOYEE (G4), SPOUSE OF A G4 (G4),
CHILD OF A G5 (G5), PERSONAL EMP. OF A G1, 2, 3, OR 4 (G5), SPOUSE OF A G5 (G5), NURSES (H1A), SPECIALTY OCCUPATION (H1B), CHILEAN SPEC.
OCCUPATION (H1B1), SINGAPOREAN SPEC. OCCUPATION (H1B1), NURSE IN SHORTAGE AREA (H1C), AGRICULTURAL WORKER (H2A),
NONAGRICULTURAL WORKER (H2B), TRAINEE (H3), CHILD OF AN H (H4), SPOUSE OF AN H (H4), CHILD OF AN I (I), FOREIGN MEDIA REPRESENTATIVE (I),
SPOUSE OF AN I (I), EXCHANGE VISITOR (J1), CHILD OF A J1 (J2), SPOUSE OF A J1 (J2), FIANCÉ(E) OF A U.S. CITIZEN (K1), CHILD OF A K1 (K2), SPOUSE OF
A U.S. CITIZEN (K3), CHILD OF A K3 (K4), INTRACOMPANY TRANSFEREE (L1), CHILD OF A L1 (L2), SPOUSE OF A L1 (L2), STUDENT (M1), CHILD OF M1 (M2),
SPOUSE OF M1 (M2), COMMUTER STUDENT (M3), CHILD OF A N8 (N9), PARENT OF CERTAIN SPECIAL IMMIGRANT (N8), CHILD OF NATO 1 (NATO1),
PRINCIPAL REPRESENTATIVE (NATO1), SPOUSE OF NATO1 (NATO1), CHILD OF NATO2 (NATO2), REPRESENTATIVE (NATO2), SPOUSE OF NATO2 (NATO2),
CHILD OF NATO3 (NATO3), SPOUSE OF NATO3 (NATO3), CLERICAL STAFF (NATO3), CHILD OF NATO4 (NATO4), OFFICIAL (NATO4), SPOUSE OF NATO4
(NATO4), CHILD OF NATO5 (NATO5), EXPERT (NATO5), SPOUSE OF NATO5 (NATO5), CHILD OF NATO6 (NATO6), SPOUSE OF NATO6 (NATO6), CIVILIAN
STAFF (NATO6), CHILD OF NATO7 (NATO7), PERSONAL EMP. OF NATO1-NATO6 (NATO7), SPOUSE OF NATO7 (NATO7), EXTRAORDINARY ABILITY (O1),
ALIEN ACCOMPANYING/ASSISTING (O2), CHILD OF O1 OR O2 (O3), SPOUSE OF O1 OR O2 (O3), OTHER IMMIGRANT VISA, OTHER - NOT LISTED,
INTERNATIONALLY RECOGNIZED ALIEN (P1), ARTIST/ENTERTAINER EXCHANGE PROG. (P2), ARTIST/ENTERTAINER IN CULTURAL PROG. (P3), CHILD OF P1,
P2 OR P3 (P4), SPOUSE OF P1, P2 OR P3 (P4), USCIS HUMANITARIAN PAROLE (HPCIS), ICE HUMANITARIAN PAROLE (HPICE), USCIS SIGNIFICANT PUBLIC
BENEFIT PAROLE (SBCIS), ICE SIGNIFICANT PUBLIC BENEFIT PAROLE (SBICE), CULTURAL EXCHANGE VISITOR (Q1), RELIGIOUS WORKER (R1), CHILD OF
R1 (R2), SPOUSE OF R1 (R2), FAMILY MEMBER OF AN INFORMANT (S7), VICTIM OF TRAFFICKING (T1), SPOUSE OF T1 (T2), CHILD OF T1 (T3), PARENT OF T1
(T4), SIBLING OF T1 (T5), ADULT/MINOR CHILD OF A DERIV BEN OF A T1 (T6), CHILD OF TN (TD), SPOUSE OF TN (TD), NAFTA PROFESSIONAL (TN), VICTIM
OF CRIME (U1), SPOUSE OF U1 (U2), CHILD OF U1 (U3), PARENT OF U1 (U4), SIBLING OF U1 (U5), LIFE ACT - SPOUSE OF LPR (V1), LIFE ACT - CHILD OF
LPR (V2), LIFE ACT - CHILD OF A V1 OR V2 (V3).

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Present Work/Education/Training
Displayed for all applicants over the age of 14.

Primary Occupation, Other Occupation, U.S Occupation Drop Down Values
Agriculture, Artist/Performer, Business, Communications, Computer Science, Culinary/Food Services, Education, Engineering, Government, Homemaker,
Legal Profession, Medical/Health, Military, Natural Science, Not Employed, Physical Sciences, Religious Vocation, Research, Retired, Social Science,
Student, Other.

42

Present Work/Education/Training
Displayed for all applicants over the age of 14. Answered “Agriculture” for Primary Occupation, “Yes” for
“Do you have other occupations?”, “Agriculture” for Other Occupation, and “Agriculture” for, “In which
occupation do you intend to work in the U.S.?”.

43

Present Work/Education/Training
Displayed for all applicants over the age of 14. Answered “Agriculture” for Primary Occupation, “No” for
the question, “Do you have other occupations?”, and “Agriculture” for, “In which occupation do you
intend to work in the U.S.?”.

44

Present Work/Education/Training
Displayed for all applicants over the age of 14. Answered “Other” for Primary Occupation, “No” for the
question, “Do you have other occupations?”, and “Other” for, “In which occupation do you intend to work
in the U.S.?”.

45

Present Work/Education/Training
Displayed for all applicants over the age of 14. Answered “Homemaker” for Primary Occupation, “No” for
the question, “Do you have other occupations?”, and “Homemaker” for, “In which occupation do you
intend to work in the U.S.?”.

46

Previous Work/Education/Training
Displayed for all applicants over the age of
14.

47

Previous Work/Education/Training
Displayed for all applicants over the age of 14. Answered “No” for both questions.

48

Previous Work/Education/Training
Displayed for all applicants over the age of 14. Answered “Yes” for both questions.

49

Additional Work/Education/Training/Travel
Displayed for all applicants. Answered “No” for all questions.

51

Additional Work/Education/Training/Travel
Displayed for all applicants. Answered “Yes” for all questions.

52

Petitioner Information
Displayed for all applicants. Answered “Self” for the question, “Petitioner is my”.

Petitioner is my: Drop Down Values
Employer, Prospective Employer, Father, Mother, Brother, Sister, Spouse, Child, Stepfather, Stepmother, Uncle, Aunt, Grandparent, In-Law, Self.

53

Petitioner Information
Displayed for all applicants. Answered “Father” for the question, “Petitioner is my”. The same questions
display for all selections besides “Self”.

54

Security and Background: Medical and Health
Displayed for all applicants. Answered “No” for all questions.

55

Security and Background: Medical and Health
Displayed for all applicants. Answered “Yes” for all questions.

56

Security and Background: Criminal
Displayed for all applicants. Answered “No” for all questions.

57

Security and Background: Criminal
Displayed for all applicants. Answered “Yes” for all questions.

58

Security and Background: Security Information 1
Displayed for all applicants. Answered “No” for all questions.

59

Security and Background: Security Information 1
Displayed for all applicants. Answered “Yes” for all questions.

60

Security and Background: Security Information 2
Displayed for all applicants. Answered “No” for all questions.

61

Security and Background: Security Information 2
Displayed for all applicants. Answered “Yes” for all questions.

62

Security and Background: Immigration Law Violations 1
Displayed for all applicants who answered “Yes” to “Have you ever been to the U.S?” on the previous U.S
Travel Page. Answered “No” for all questions.

63

Security and Background: Immigration Law Violations 1
Displayed for all applicants who answered “Yes” to “Have you ever been to the U.S?” on the previous U.S
Travel Page. Answered “Yes” for all questions.

64

Security and Background: Immigration Law Violations 2
Displayed for all applicants who answered “Yes” to “Have you ever been to the U.S?” on the previous U.S
Travel Page. Answered “No” for all questions.

65

Security and Background: Immigration Law Violations 2
Displayed for all applicants who answered “Yes” to “Have you ever been to the U.S?” on the previous U.S
Travel Page. Answered “Yes” for all questions.

66

Security and Background: Miscellaneous 1
Displayed for all applicants. Answered “No” for all questions.

67

Security and Background: Miscellaneous 1
Displayed for all applicants. Answered “Yes” for all questions.

68

Security and Background: Miscellaneous 2
Displayed for all applicants. Answered “No” for all questions.

69

Security and Background: Miscellaneous 2
Displayed for all applicants. Answered “Yes” for all questions.

70

Social Security Number
Displayed for all applicants. Answered “No” for all questions.

71

Social Security Number
Displayed for all applicants. Answered “Yes” for all questions.

72

Social Security Number
Displayed for all applicants. Answered “Yes” for the first four questions with the last question answered
“No”.

73

Review and Submit
Displayed for all applicants. This page lists the applicant’s responses for all questions asked on all pages
of the Gold Visa Application. The full review page with all questions is not depicted in the exemplar.

74

Sign and Submit
Displayed for all
applicants. Answered "No"
to "Did anyone assist you in
filling out this application?"

75

Sign and Submit
Displayed for all
applicants. Answered
"Yes" to "Did anyone assist
you in filling out this
application?"

76

Sign and Submit Displayed for all female applicants from
designated FGM countries. Answered "No" to "Did anyone assist
you in filling out this application?" and displays FGM fact sheet
information

75

Confirmation
Displayed for all
applicants.

77

Application Submitted / Document Upload
Displayed for all applicants.

Document Type Drop Down Values
Birth Certificate, Criminal Court and Prison Records, Death Certificate, Marriage Certificate, Marriage Termination, Military Records, Passport, Police
Certificate, Deportation Documentation.

78