PLEASE REVIEW THE FOLLOWING QUESTIONS
BEFORE STARTING FILLING OUT THE FORM.
Social Security Number:
Place of Birth (City/Country):
Date of Birth (Month/Date/Year):
Country of Citizenship:
Current Non Immigrant Visa:
Latest Date of Arrival at the U.S. Port:
Permanent Address outside of the U.S. (Hometown Address):
Address in the U.S. where you reside:
(If different form present address)
Dates and prior Periods of Stay in the U.S. for the past 6 Years:
Type of Visa
*Please review your answers before submitting.