Fillable Online Immigrant Visa and Alien Registration Application (DS-260)

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Online Immigrant Visa and Alien Registration Application (DS-260)

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The Online Immigrant Visa and Alien Registration Application (DS-260) form is 17 pages long and contains:

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  • 180 check-boxes
  • 281 other fields

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Online Immigrant Visa and Alien Registration Application (DS-260)
Personal, Address, and Phone Information
Name Provided: _______________________
Full Name in Native Language: _______________________
Other Names Used: _______________________
Sex: _______________________
Current Marital Status: _______________________
Date of Birth: _______________________
City of Birth: _______________________
State/Province of Birth: _______________________
Country/Region of Birth: _______________________
Country/Region of Origin (Nationality): _______________________
Document Type: _______________________
Document ID: _______________________
Country/Authority that Issued Document: _______________________
Document Type: _______________________
Document ID: _______________________
Country/Authority that Issued Document: _______________________
Issuance Date: _______________________
Expiration Date: _______________________
Do you hold or have you held any nationality other than the one you have indicated above?
Yes No
Other Country/Region of Origin (Nationality): _______________________
Do you hold a passport from the country/region of origin (nationality) above? Yes No
Passport Number: _______________________
Present Address: _______________________
City: _______________________
State/Province: _______________________
Postal Zone/ZIP Code: _______________________
Country/Region: _______________________
From Date: _______________________
Have you lived anywhere other than this address since the age of sixteen? Yes No
Previous Address (1): _______________________
City: _______________________
State/Province: _______________________
Postal Zone/ZIP Code: _______________________
Country/Region: _______________________
From: _______________________
To: _______________________
Previous Address (2): _______________________
City: _______________________
State/Province: _______________________
Postal Zone/ZIP Code: _______________________
Country/Region: _______________________
From: _______________________
To: _______________________
Previous Address (3): _______________________
City: _______________________
State/Province: _______________________
Postal Zone/ZIP Code: _______________________
Country/Region: _______________________
From: _______________________
To: _______________________
Previous Address (4): _______________________
City: _______________________
State/Province: _______________________
Postal Zone/ZIP Code: _______________________
Country/Region: _______________________
From: _______________________
To: _______________________
Previous Address (5): _______________________
City: _______________________
State/Province: _______________________
Postal Zone/ZIP Code: _______________________
Country/Region: _______________________
From: _______________________
To: _______________________
Primary Phone Number: _______________________
Secondary Phone Number: _______________________
Work Phone Number: _______________________
Email Address: _______________________
Is your Mailing Address the same as your Present Address? Yes No
Address: _______________________
City: _______________________
State/Province: _______________________
Postal Zone/ZIP Code: _______________________
Country/Region: _______________________
Do you have an address in the United States where you intend to live? Yes No
Name of person currently living at address: _______________________
U.S. Address: _______________________
Phone Number: _______________________
Is this address where you want your Permanent Residence Card (Green Card) mailed?
Yes No
Contact Person: _______________________
Address: _______________________
City: _______________________
State: _______________________
ZIP Code: _______________________
Phone Number: _______________________
Family Information
Father’s Surnames: _______________________
Father’s Given Names: _______________________
Date of Birth: _______________________
City of Birth: _______________________
State/Province of Birth: _______________________
Country/Region of Birth: _______________________
Is your father still living? Yes No
Year of death: _______________________
Mother’s Surnames: _______________________
Mother’s Given Names: _______________________
Date of Birth: _______________________
City of Birth: _______________________
State/Province of Birth: _______________________
Country/Region of Birth: _______________________
Is your mother still living? Yes No
Year of death: _______________________
Do you have any previous spouses? Yes No
Previous Spouse Name (1): _______________________
Date of Birth: _______________________
Date of Marriage: _______________________
Date Marriage Ended: _______________________
How was your marriage terminated? _______________________
Country/Region where marriage was terminated: _______________________
Previous Spouse Name (2): _______________________
Date of Birth: _______________________
Date of Marriage: _______________________
Date Marriage Ended: _______________________
How was your marriage terminated? _______________________
Country/Region where marriage was terminated: _______________________
Do you have any children? Yes No
Number of Children: _______________________
Child Name (1): _______________________
Date of Birth: _______________________
City of Birth: _______________________
State of Birth: _______________________
Country/Region of Birth: _______________________
Does this child live with you? Yes No
Address: _______________________
City: _______________________
State/Province: _______________________
Postal Zone/ZIP Code: _______________________
Country/Region: _______________________
Is this child immigrating to the U.S. with you? Yes No
Is this child immigrating to the U.S. at a later date to join you? Yes No
Child Name (2): _______________________
Date of Birth: _______________________
City of Birth: _______________________
State of Birth: _______________________
Country/Region of Birth: _______________________
Does this child live with you? Yes No
Address: _______________________
City: _______________________
State/Province: _______________________
Postal Zone/ZIP Code: _______________________
Country/Region: _______________________
Is this child immigrating to the U.S. with you? Yes No
Is this child immigrating to the U.S. at a later date to join you? Yes No
Child Name (3): _______________________
Date of Birth: _______________________
City of Birth: _______________________
State of Birth: _______________________
Country/Region of Birth: _______________________
Does this child live with you? Yes No
Address: _______________________
City: _______________________
State/Province: _______________________
Postal Zone/ZIP Code: _______________________
Country/Region: _______________________
Is this child immigrating to the U.S. with you? Yes No
Is this child immigrating to the U.S. at a later date to join you? Yes No
Child Name (4): _______________________
Date of Birth: _______________________
City of Birth: _______________________
State of Birth: _______________________
Country/Region of Birth: _______________________
Does this child live with you? Yes No
Address: _______________________
City: _______________________
State/Province: _______________________
Postal Zone/ZIP Code: _______________________
Country/Region: _______________________
Is this child immigrating to the U.S. with you? Yes No
Is this child immigrating to the U.S. at a later date to join you? Yes No
Child Name (5): _______________________
Date of Birth: _______________________
City of Birth: _______________________
State of Birth: _______________________
Country/Region of Birth: _______________________
Does this child live with you? Yes No
Address: _______________________
City: _______________________
State/Province: _______________________
Postal Zone/ZIP Code: _______________________
Country/Region: _______________________
Is this child immigrating to the U.S. with you? Yes No
Is this child immigrating to the U.S. at a later date to join you? Yes No
Previous U.S. Travel Information
Have you even been in the U.S.? Yes No
Where you issued an Alien Registration Number by the Department of Homeland Security?
Yes No
Alien Registration Number: _______________________
Provide information on your last five U.S. visits.
Date Arrived (1): _______________________
Length of Stay: _______________________
Date Arrived (2): _______________________
Length of Stay: _______________________
Date Arrived (3): _______________________
Length of Stay: _______________________
Date Arrived (4): _______________________
Length of Stay: _______________________
Date Arrived (5): _______________________
Length of Stay: _______________________
Have you even been issued a U.S. Visa? Yes No
Date Visa Was Issued: _______________________
Visa Classification: _______________________
Visa Number: _______________________
If you answer yes to any of the following questions, please explain below:
Have any of your U.S. visas ever been lost or stolen? Yes No
Have any of your U.S. visas ever been cancelled or revoked? Yes No
Have you ever been refused a U.S. visa, been refused admission to the U.S., or withdrawn your
application for admission at the port of entry? Yes No
If you answered yes to any of these questions, please explain: ____________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Work, Education, and Training Information
Primary Occupation: _______________________
Do you have any other occupations? Yes No
Other Occupations: _______________________
In which occupation do you intend to work in the U.S.: _______________________
Were you previously employed? Yes No
Employer Name (1): _______________________
Employer Street Address: _______________________
City: _______________________
State/Province: _______________________
Postal Zone/ZIP Code: _______________________
Country/Region: _______________________
Telephone Number: _______________________
Job Title: _______________________
Supervisor’s Surnames: _______________________
Supervisor’s Given Names: _______________________
Employment Date From: _______________________
Employment Date To: _______________________
Employer Name (2): _______________________
Employer Street Address: _______________________
City: _______________________
State/Province: _______________________
Postal Zone/ZIP Code: _______________________
Country/Region: _______________________
Telephone Number: _______________________
Job Title: _______________________
Supervisor’s Surnames: _______________________
Supervisor’s Given Names: _______________________
Employment Date From: _______________________
Employment Date To: _______________________
Employer Name (3): _______________________
Employer Street Address: _______________________
City: _______________________
State/Province: _______________________
Postal Zone/ZIP Code: _______________________
Country/Region: _______________________
Telephone Number: _______________________
Job Title: _______________________
Supervisor’s Surnames: _______________________
Supervisor’s Given Names: _______________________
Employment Date From: _______________________
Employment Date To: _______________________
Employer Name (4): _______________________
Employer Street Address: _______________________
City: _______________________
State/Province: _______________________
Postal Zone/ZIP Code: _______________________
Country/Region: _______________________
Telephone Number: _______________________
Job Title: _______________________
Supervisor’s Surnames: _______________________
Supervisor’s Given Names: _______________________
Employment Date From: _______________________
Employment Date To: _______________________
Employer Name (5): _______________________
Employer Street Address: _______________________
City: _______________________
State/Province: _______________________
Postal Zone/ZIP Code: _______________________
Country/Region: _______________________
Telephone Number: _______________________
Job Title: _______________________
Supervisor’s Surnames: _______________________
Supervisor’s Given Names: _______________________
Employment Date From: _______________________
Employment Date To: _______________________
Have you attended any educational institutions at a secondary level or above? Yes No
Number of Educational Institutions Attended: _______________________
Name of Institution (1): _______________________
Address of Institution: _______________________
City: _______________________
State/Province: _______________________
Postal Zone/ZIP Code: _______________________
Country/Region: _______________________
Course of Study: _______________________
Degree or Diploma: _______________________
Date of Attendance From: _______________________
Date of Attendance To: _______________________
Name of Institution (2): _______________________
Address of Institution: _______________________
City: _______________________
State/Province: _______________________
Postal Zone/ZIP Code: _______________________
Country/Region: _______________________
Course of Study: _______________________
Degree or Diploma: _______________________
Date of Attendance From: _______________________
Date of Attendance To: _______________________
Have you ever served in the military? Yes No
Name of Country/Region: _______________________
Branch of Service: _______________________
Rank/Position: _______________________
Military Specialty: _______________________
Date of Service From: _______________________
Date of Service To: _______________________
Petitioner Information
Petitioner is my: _______________________
Petitioner Name: _______________________
Petitioner Address: _______________________
City: _______________________
State/Province: _______________________
Postal Zone/ZIP Code: _______________________
Country/Region: _______________________
Telephone: _______________________
Mobile/Cell Telephone: _______________________
Email Address: _______________________
Security and Background Information
• Do you have a communicable disease of public health significance such as tuberculosis (TB)?
Yes No
• Do you have documentation to establish that you have received vaccinations in accordance
with U.S. law? Yes No
• 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
• Are you or have you ever been a drug abuser or addict? Yes No
• Have you ever been arrested or convicted for any offense or crime, even though subject or a
pardon, amnesty, or other similar action? Yes No
• Have you ever violated, or engaged in a conspiracy to violate, any law relating to controlled
substances? Yes No
• Are you the spouse, son, or daughter of an individual who has violated any controlled
substance trafficking law, and have knowingly benefited from the trafficking activities in the
past five years? Yes No
• 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
• Have you ever been involved in, or do you seek to engage in, money laundering?
Yes No
• Have you ever committed or conspired to commit a human trafficking offense in the United
States or outside the United States? Yes No
• Have you ever knowingly aided, abetted, assisted, or colluded with 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? Yes No
• 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 No
• Do you seek to engage in espionage, sabotage, export control violations, or any other illegal
activity while in the United States? Yes No
• Do you seek to engage in terrorist activities while in the United States or have you ever
engaged in terrorist activities? Yes No
• Have you ever or do you intend to provide financial assistance or other support to terrorists or
terrorist organizations? Yes No
• Are you a member or representative of a terrorist organization? Yes No
• Have you ever ordered, incited, committed, assisted, or otherwise participated in genocide?
Yes No
• Have you ever committed, ordered, incited, assisted, or otherwise participated in torture?
Yes No
• Have you committed, ordered, incited, assisted, or otherwise participated in extrajudicial
killings, political killings, or other acts of violence? Yes No
• Have you ever engaged in the recruitment of or the use of child soldiers? Yes No
• 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
• Are you a member of or affiliated with the Communist or other totalitarian party?
Yes No
• Have you ever directly or indirectly assisted or supported any of the groups in Columbia
known as the Revolutionary Armed Forces of Columbia (FARC), National Liberation Army
(ELN), or United Self-Defense Forces of Columbia (AUC)? Yes No
• 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
• 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
• 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 choice? Yes No
• 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
• 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
• 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
• Have you ever been the subject of a removal or deportation hearing? Yes No
• Have you failed to attend a hearing on removability or inadmissibility within the last five
years? Yes No
• Have you ever been unlawfully present, overstayed the amount of time granted by an
immigration official or otherwise violated the terms of a U.S. visa? Yes No
• Are you subject to a civil penalty under INA 274C? Yes No
• Have you been ordered removed from the U.S. during the last five years? Yes No
• Have you been ordered removed from the U.S. for a second time within the last 20 years?
Yes No
• Have you ever been unlawfully present and ordered removed from the U.S. during the last ten
years? Yes No
• Have you ever been convicted of an aggravated felony and been ordered removed from the
U.S.? Yes No
• 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
• Have you ever been unlawfully present in the U.S. for more than one year or more than one
year in the aggregate at any time during the last 10 years? Yes No
• 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
• Have you ever intentionally assisted another person in withholding custody of a U.S. citizen
child outside the United States from a person granted legal custody by a U.S. court?
Yes No
• Have you voted in the United States in violation of any law or regulation? Yes No
• Have you ever renounced United States citizenship for the purpose of avoiding taxation?
Yes No
• Have you attended a public elementary school or a public secondary school on student (F)
status after November 30, 1996 without reimbursing the school? Yes No
• Do you seek to enter the United States for the purpose of performing skilled or unskilled labor
but have not yet been certified by the Secretary of Labor? Yes No
• 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
• Are you a health care 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
• Are you permanently ineligible for U.S. citizenship? Yes No
• Have you ever departed the United States in order to evade military service during a time of
war? Yes No
• Are you coming to the U.S. to practice polygamy? Yes No
• Are you a former exchange visitor (J) who has not yet fulfilled the two-year foreign residence
requirement? Yes No
• Has the Secretary of Homeland Security of the United States ever determined that you
knowingly made a frivolous application for asylum? Yes No
• Are you likely to become a public charge after you are admitted to the United States?
Yes No
If you answer yes to any of the following questions, please explain below:__________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Social Security Number Information
Have you every applied for a Social Security number?
Do you want the Social Security Administration to issue a Social Security number and a card?
Do you authorize disclosure of information from this form to the Department of Homeland
Security, the Social Security Administration, and such other U.S. Government agencies as may
be required for the purposes of assigning you a Social Security number (SSN) and issuing you a
Social Security card and do you authorize the Social Security Administration to share your SSN
with the Department of Homeland Security?
Yes
Yes
Yes
No
No
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Online Immigrant Visa and Alien Registration Application (DS-260)

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Completed 21 May 2021

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