Name:
Zip Code:
Present
Address:
Email (required
):
City:
Home Phone:
State:
Country:
Your
birthplace:
City:
Country:
Father's
birthplace:
City: Country:
Mother's
birthplace:
City: Country:
Your
country of citizenship:
Your
country of legal residence, if different from country of
citizenship:
Do
you have any relatives who are U.S. citizens or residents?
Yes
If so,
please state their relation to you and their present
visa status:
Do
you have any relatives who were, but are not now, U.S.
citizens or residents?
Yes
If
so, please state their relation to you and their past and
present visa status:
Martial
Status:
Single
Date
you last entered the U.S. (if
applicable) :
Month/Day/Year:
Visa
status when you entered the U.S. (if
applicable) :
Present
visa status (if applicable) :
Date
visa expires (if applicable) :
Month/Day/Year:
Have
you ever been in the US previously?
Yes
If yes, in
which status?
If yes,
for how long?
Education:
Highest
Degree Achieved (e.g.,high school, college, graduate, etc.):
Year received
degree:
Employment:
Occupation:
Have
you ever applied for permanent legal residence in the United
States:
Yes
