U.S. Visa Questionnaire
Name (Required)
Date of Birth
Passport Number
Personal Information
Current Resident Address
Primary Phone Number
Secondary Phone Number
Travel Information
Purpose of Your Trip to the United States
Address Where You Will Stay in the United States
Who Will Be Paying for Your Trip?
Is a Company or Organization Paying for Your Trip?
Yes
No
Company/Organization Name
Company/Organization Telephone Number
Company/Organization Address
Are There Any Other Persons Traveling with You?
U.S. Travel History
Have You Ever Been in the United States Before?
Have You Ever Been Issued a U.S. Visa?
No
Yes
Have You Ever Been Refused a U.S. Visa?
Have You Ever Stayed in the U.S.?
Do You Have a Contact Person in the U.S.?
Yes
No
Name of Contact Person
Organization Name
Contact Address
Contact Phone Number
Contact Email Address
Have you traveled to any countries/regions within the last five years?
Yes
No
If yes, please list the countries/regions (separate by commas):
Family Information
Father's Full Name
Father's Date of Birth
Mother's Full Name
Mother's Date of Birth
Spouse's Full Name
Spouse's Date of Birth
Do you have any immediate relatives, not including your parents, in the United States? If yes, provide details.
Education Information
Have You Attended Any Educational Institutions?
Yes
No
Institution Name
Course of Study
Date of Attendance (From and To)
Present Work Information
Employer Name
Job Title
Employment Dates
Previous Employment Information
Were You Previously Employed?
Yes
No
Employer Name
Job Title
Employment Dates
Submit