Lawform

l. APPLICATION (DS-260)
Case Number:
Confirmation Number:
l. PERSONAL INFORMATION
Name:
Present marital status:	Single Married (Please fill Section II) Widowed Divorced (Please fill Section III)
Sex:	Male Female
Date of Birth:		City and Country of Birth:
Document Type:
Document ID:
Authority that Issued Document:
Issuance Date(mm/dd/yyyy):
Expiration Date(mm/dd/yyyy):
Do you hold or have you held any nationality other than the one you have indicated above:
Current Address:
City:
State/Province:
Zip Code:
Country/Region:
Date of Residency From(mm/dd/yyyy):
To (mm/dd/yyyy):
Have you lived anywhere else other than address since the age of 16?:
If yes list all the addresses:
Primary Phone Number:
Secondary Phone Number:
Work Phone Number:
Email Address:
Is your Mailing Address the same as your Present Address?:
Do you have an address in the United States where you intend to live?:
Name of person currently living at address:
U.S Address:
U.S Phone Number:
Is this address where you want your Permanent Residence Card(Green Card) mailed?:

ll. FAMILY INFORMATION
Father's Last Name:
Father’s Given Name:
Date of Birth:		City and Country of Birth:
Is your father still living If yes Where?:
Year of Death:
Mother's Last Name:
Mother’s Given Name:
Date of Birth:		City and Country of Birth:
Is your Mother still living If yes Where?:
Spouse’s full name:
Spouse’s Date of Birth:		City and Country of Birth:
Spouse’s Address:
Occupation:
Date of Marriage:		City and Country of Marriage:
Is your Spouse immigrating to U.S. with you?:		Immigration status (if not U.S. citizen):
Is your Spouse immigrating to U.S. at later date to join you?:
Do you have any previous Spouse?:

lll. Previous U.S. Travel Information
Have you ever been in the U.S.?
Have you ever been issued a U.S. Visa?
Have you ever been refused a U.S. Visa, been refused admission to the United States, or withdrawn your application for admission at the port of entry?

lV. Work/ Education/ Training Information
Primary Occupation
Job experience
Were you previously employed?
Employer Name
Employer Address
Telephone Number:
Job Title
Supervisor’s last Name
Supervisor’s Given Name
Employment Date From (mm/dd/yyyy)
Employment Date To (mm/dd/yyyy)
Have you attended any educational institutions?
Number of Educational Institution 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: (mm/dd/yyyy)
Date of Attendance To: (mm/dd/yyyy)
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: (mm/dd/yyyy)
Date of Attendance To: (mm/dd/yyyy)
Have you ever served in the Military?
Have you belonged to, contributed to, or worked for any professional, social, or charitable organization?
Do you have any Specialized skills or training, including firearms, Explosives, Nuclear, Biological, Or Chemical experience?
Have you ever served in, been a member of, or been involved with a paramilitary unit, vigilante unit, rebel group, guerrilla group, or insurgent organization?
Can you speak and/or read languages other than your native language?
List the language that you speak and/or read