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DS-160 preparation assistance form reviewed by a California Registered Immigration Consultant (Registration No. ACC006A001126)

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Consultation Folio: DS160-US-532579-PT

Simplified Private Application Form for US Visa (Young adult +18)

For any question you don't know the answer to, you can leave it blank and the migration consultant will assist you with your form.

This security step will help you recover your information.

Select a location where you will be applying for this visa
Security Question

Personal Information 1

NOTE: Data on this page must match the information as it is written in your passport.

Sex
Male
Female
Have you used other names (for example: maiden names, religious names, professional names, aliases, etc.)?

Help: Other names used may include, but are not limited to: Maiden name, Religious name, Professional name, or any other name by which you have been referred to or have been referred to in the past

Birthday
Month
Day
Year
Country/Region of Origin (Nationality)
Do you hold or have you held any nationality other than the one indicated above on nationality?
Yes
No
Are you a permanent resident of a country/region other than your country/region of origin (nationality) indicated above?
Marital Status

Personal Information 2

If you don't have one, click on: Not applicable

Selection
Not applicable

United States Social Security Number

If you don't have one, click on: Not Applicable

Selection
Not applicable

Travel Information

Select the Visa
Have you made specific travel plans?
Yes
No

Travel Companions Information

Are there other persons traveling with you?

Previous U.S. Travel Information

Have you ever been in the U.S.?
Yes
No
Have you ever been issued a U.S. Visa?
Have you ever been refused a U.S. Visa, or been refused admission to the United States, or withdrawn your application for admission at the port of entry?

Address and Phone Information

Home Address

This should be the number they are most likely to reach you at.

Address where you will be staying in the United States

Do you have a social media presence?

Passport Information

Passport/Travel Document Type
Country/Authority that Issued Passport/Travel Document

City / State/Province/ Country

Issuance Date
Month
Day
Year
Expiration Date
Month
Day
Year

U.S. Point of Contact Information (Your U.S. Point of Contact can be any individual in the U.S. who knows you and can verify, if necessary, your identity. If you do not personally know anyone in the U.S., you may enter the name of the store, company, or organization you plan to visit during your trip.)

Relationship to You Click here for more information

City/State/ZIP Code/

Family Information: Relatives

NOTE: Please provide the following information about your biological parents. If you are adopted, please provide the following information about your adoptive parents. If you do not know the information, leave the field blank.

Father's Full Name and Date of Birth

Date
Month
Day
Year

Mother's Full Name and Date of Birth

Date
Month
Day
Year
Do you have any immediate family members in the United States, including your parents?
Yes
No

Present Work/Education/Training Information

NOTE: Provide the following information concerning your current employment or education.

Primary Occupation
Service
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