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U.S.

Department of State
Online Immigrant Visa & Alien Registration Application Questionnaire (DS -260)

Personal, Address, and Phone Information:


Name of Foreign National: ______________________________________________________________
Other Names Used: _________________________________________________________________
Gender: ______________________
Current Marital Status: __________________
Date of Birth: _______________
City of Birth: ________________
State/Province of Birth: ____________________________________________
Nationality: _______________________________________
Passport Number: _______________________________
Date Passport was issued: ________________________
Date Passport Expires: ____________________________
Do you hold any or have you held any nationality other than the one you have indicated above? ________
If so what other nationalities do you claim? _________________________________________________
Current Address: ______________________________________________________________________
Date you started living at current address: __________________________________________________
Have you lived anywhere other than this address since the age of sixteen? _______________________
If yes, Please include them below

Number and City State/Province Postal Country Date Date


Street Name Code/ Zip Moved In Moved
Code Out
Telephone Number: ____________________________
Work Phone Number: __________________________
Email Address: ________________________________
Is your mailing address the same as your present address?
If not, please include your mailing address:

Number and City State/Province Postal Code/ Zip Country


Street Name Code

Permanent Address of Petitioner: _________________________________________________________


Name of Person currently living at address: _________________________________________________
Phone Number: _______________________________________________________________________
Please provide the address in the United States where you want your Permanent Residence Card mailed:

Number and City State/Province Postal Code/ Zip Country


Street Name Code

Family Information for Foreign National


Father’s Surname: _____________________________________
Father’s Given Name: ___________________________________
Date of Birth: ____________________________
City of Birth: ____________________________
State/Province of Birth: _____________________
Is your father still living? ___________________ If not living year of death: _____________
Current Address of Father: _______________________

Mother’s Surname: _____________________________________


Mother’s Given Name: ___________________________________
Date of Birth: ____________________________
City of Birth: ____________________________
State/Province of Birth: _____________________
Is your mother still living? ___________________ If not living year of death: _____________
Is your mother’s address the same as your father’s? _____________________________________
If not, please include address: _________________________________________________________

Spouse’s Full Name: _______________________________________


Spouse’s Date of Birth: ______________________________________
Spouse’s City of Birth: _______________________________________
Spouse’s State/Province of Birth: ________________________________
Spouse’s Country of Birth: _____________________________________
Spouse’s Occupation: ___________________________________________
Date of Marriage: _________________________________
Marriage State and Country: _______________________________________
Is your spouse immigrating to the U.S. with you?
Is your spouse immigration to the U.S. at a later date to join? ______________________
Do you have any previous spouses? _______________________________________________
If Yes,

Full Name Date of Birth Date of State & Date of State &
Marriage Country of Divorce Country of
Marriage Divorce

List all of your children: Child #1 Child #2 Child #3

Last name

First name
Middle name

Male or Female?

Date of birth

Place of birth

A# (if any)

Applying with you?

Living with you? ☐ Yes ☐ No ☐ Yes ☐ No ☐ Yes ☐ No

If they do not live with you provide their address:


Child 1: ________________________________________________________________________
Child 2: ________________________________________________________________________
Child 3: ________________________________________________________________________

Previous United States Travel Information for Foreign National:


Have you ever been in the United States? _____________________
Were you issued an Alien Registration Number by the Department of Homeland Security? If so please
include the number. ____________________________
Provide information on your last five U.S. Visits:

Date Arrived in the United States Length of Stay


1
2
3
4
5

Have you ever been issued a U.S. Visa? __________________ If yes, type of 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? __________ If Yes, Explain: _______________________
____________________________________________________________________________________
____________________________________________________________________________________
Work, Education, Training Information for Foreign National:
Primary Occupation: __________________________________________
Present Employer of School Name: _______________________________________________
Address of Employer or School: __________________________________________________
State/Province Employer is located: _______________________________________________
Country Employer is located: ____________________________________________________
Do you have any other occupations: _______________________________________________ If so,
provide Address, State/Province and County: ________________________________________________
In which occupation do you intent to work in the U.S? _________________________________________
Have you ever served in the military? _______________________________

Petitioner Information:
How are you related to the foreign national? _____________________________
Petitioner Name: ____________________________________
Petitioner Address: _______________________________________________________________
Telephone Number: __________________________________
Email Address: _________________________________________________________-

Security and Background Information for Foreign National:


Do you have a communicable disease of health significance such as ☐ Yes ☐ No
tuberculosis (TB)?
Do you have documentation to establish that you have received ☐ Yes ☐ No
vaccinations in accordance with U.S. law?
Do you have a mental or physical disorder that poses or is likely to pose ☐ Yes ☐ No
a threat to the safety or welfare of yourself or others?
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 ☐ Yes ☐No
though subject of a pardon, amnesty, or other similar action?
Have you ever violated, or engaged in a conspiracy to violate, any law
relating to controlled substances?
Are you the spouse, son, or daughter of an individual who has violated ☐ Yes ☐No
any controlled trafficking law, and have knowingly benefited from the
trafficking activities in the past five years?
Are you coming to the United States to engage in prostitution or ☐ Yes ☐ No
unlawful commercialized vice or have you been engaged in prostitution
or procuring prostitutes within the past 10 years?
Have you ever been involved in, or do you seek to engage in, money ☐ Yes ☐ No
laundering?
Have you ever committed or conspired to commit a human trafficking ☐ Yes ☐ No
offense in the United States or outside the United States?
Have you ever knowingly aided, abetted, assisted, or colluded with an ☐ Yes ☐ No
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?
Are you the spouse, son, or daughter of an individual who has committed ☐ Yes ☐ No
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?
Do you seek to engage in espionage, sabotage, export control violations, ☐ Yes ☐ No
or any other illegal activity while in the United States?
Do you seek to engage in terrorist activities while in the United States or ☐ Yes ☐ No
have you ever engaged in terrorist activities?
Have you ever or do you intent to provide financial assistance or other ☐ Yes ☐ No
support to terrorists or terrorist organizations?
Are you a member or representative of a terrorist organization?
Have you ever ordered, incited, committed, assisted, or otherwise ☐ Yes ☐ No
participated in genocide?
Have you ever committed, ordered, incited, assisted, or otherwise ☐ Yes ☐ No
participated in torture?
Have you ever committed, ordered, incited, assisted, or otherwise ☐ Yes ☐ No
participated in extrajudicial killings, political killings, or other acts of
violence?
Have you ever engaged in the recruitment of or use of child soldiers? ☐ Yes ☐ No
Have you, while serving as a government official, been responsible for ☐ Yes ☐ No
or directly carried out, at any time, particularly severe violations of
religious freedom?
Are you a member of or affiliated with the Communist or other ☐ Yes ☐ No
totalitarian party?
Have you ever directly or indirectly assisted or supported any of the ☐ Yes ☐ No
groups in Columbia known as the Revolutionary Armed Forces of
Columbia (FARC), National Liberation Army (ELN), or United Self-
Defense Forces of Columbia (AUC)?
Have you ever, through abuse of government or political position ☐ Yes ☐ No
converted for personal gain, confiscated or expropriated property in a
foreign nation to which a United States national has claim of ownership?
Are you the spouse, minor child, or agent of an individual who has ☐ Yes ☐ No
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?
Have you ever been directly involved in the establishment or ☐ Yes ☐ No
enforcement of population controls forcing a women to undergo an
abortion against her free choice or a man or a women to undergo
sterilization against his or her free choice?
Have you ever disclosed or trafficked in confidential U.S. business ☐ Yes ☐ No
information obtained in connection with U.S. participation in the
Chemical Weapons Convention?
Are you the spouse, minor child, or agent of an individual who has ☐ Yes ☐ No
disclosed or trafficked in confidential U.S. business information obtained
in connection with U.S. participation in the Chemical Weapons
Convention?
Have you ever sought to obtain or assist other to obtain a visa, entry into ☐ Yes ☐ No
the United States, or any other United States immigration benefit by
fraud or willful misrepresentation or other unlawful means?
Have you ever been the subject or a removal or deportation hearing? ☐ Yes ☐ No
Have you failed to attend a hearing on removability or inadmissibility ☐ Yes ☐ No
with the last five years?
Have you ever been unlawfully present, overstayed the amount of time ☐ Yes ☐ No
granted by an immigration official or otherwise violated the terms of a
U.S. visa?
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 ☐ Yes ☐ No
the last 20 years?
Have you ever been unlawfully present and ordered removed from the ☐ Yes ☐ No
U.S. during the last ten years?
Have you ever been convicted of an aggravated felony and been ordered ☐ Yes ☐ No
removed from the U.S.?
Have you ever been unlawfully present in the U.S. for more than 180 ☐ Yes ☐ No
days (but no more than one year) and have voluntarily departed the U.S.
within the last three years?
Have you ever been unlawfully present in the U.S. for more than one ☐ Yes ☐ No
year or more than one year in the aggregate at any time during the last 10
years?
Have you ever withheld the custody of a U.S. citizen child outside the ☐ Yes ☐ No
United States from a person granted legal custody by a U.S. Court?
Have you ever intentionally assisted another person in withholding ☐ Yes ☐ No
custody of a U.S. citizen child outside the United States from a person
granted legal custody by a U.S. court?
Have you voted in the United States in violation of any law or ☐ Yes ☐ No
regulation?
Have you ever renounced United States citizenship for the purpose of ☐ Yes ☐ No
avoiding taxation?
Have you attended a public elementary school or public secondary ☐ Yes ☐ No
school on student (F) status after November 30, 1996 without
reimbursing the school?
Do you seek to enter the United States for the purpose of performing ☐ Yes ☐ No
skilled or unskilled labor but have not yet been certified by the Secretary
of Labor?
Are you a graduate of a foreign medical school seeking to perform ☐ Yes ☐ No
medical services in the United States but have not yet passed the
National Board of Medical Examiners examinations or its equivalent?
Are you a health care worker seeking to perform such work in the United ☐ Yes ☐ No
States but have not yet received certifications from the Commission on
Graduates of Foreign Nursing Schools or an equivalent approved
independent credentialing organization?
Are you permanently ineligible for U.S. Citizenship? ☐ Yes ☐ No
Have you ever departed the United States in order to evade military ☐ Yes ☐ No
service during a time of year?
Are you coming to the United States to practice polygamy? ☐ Yes ☐ No
Are you a former exchange visitor (J) who has not yet fulfilled the two- ☐ Yes ☐ No
year foreign residence requirement?
Has the Secretary of Homeland Security of the United States ever ☐ Yes ☐ No
determined that you knowingly made a frivolous application for
Asylum?
Are you likely to become a public charge after you are admitted to the ☐ Yes ☐ No
United States?

Social Security Number Information:


Have you ever applied for a Social Security Number? __________________________
If so, what is the number: ______________________________
Do you want the SSA to issue you a Social Security Number and a card? ___________________
Do you authorize the 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 ☐ No