PersonalInformation1OMBCONTROLNUMBER:1405-0185FORMNUMBER:DS-260EXPIRATIONDATE:01/31/2016ESTIMATEDBURDEN:120MINNOTE:Dataonthispagemustmatchtheinformationasitiswritteninyourpassportortraveldocuments.SurnamesGivenNamesFullNameinNativeAlphabetHaveyoueverusedothernames(i.e.,maiden,religious,professional,alias,etc.)?（yes）(no)Sex(male)female)CurrentMaritalStatusDateofBirth(Format:DD-MMM-YYYY)CityofBirthState/ProvinceofBirthCountry/RegionofBirthPersonalInformation2Country/RegionofOrigin(Nationality)DocumentTypeDocumentIDCountry/AuthoritythatIssuedDocumentIssuanceDate(Format:DD-MMM-YYYY)ExpirationDate(Format:DD-MMM-YYYY)Doyouholdorhaveyouheldanynationalityotherthantheoneyouhaveindicatedabove?(yes)(no)PresentAddressStreetAddress(Line1)StreetAddress(Line2)*OptionalCityState/ProvincePostalZone/ZIPCodeCountry/RegionStartedLivingHere(Format:MMM-YYYY)PreviousAddressesHaveyoulivedanywhereotherthanthisaddresssincetheageofsixteen?(Dateyouturnedsixteen:23-Mar-2001)(yes)(no)StreetAddress(Line1)StreetAddress(Line2)*OptionalCityState/ProvincePostalZone/ZIPCodeCountry/RegionStartedLivingHere(Format:MMM-YYYY)ToDate(Format:MMM-YYYY)PhonePrimaryPhoneNumberSecondaryPhoneNumberWorkPhoneNumberEmailEmailAddressMailingandPermanentAddressInformationIsyourMailingAddressthesameasyourPresentAddress?(yes)(no)PermanentAddressPleaseprovidethefollowinginformationonwhereyouintendtoliveafterarrivalintheUnitedStates.NameofpersoncurrentlylivingataddressU.S.StreetAddress(Line1)U.S.StreetAddress(Line2)*OptionalCityStateZIPCodePhoneNumberIsthisaddresswhereyouwantyourPermanentResidenceCard(GreenCard)mailed?(yes)(no)FamilyInformation:ParentsFatherSurnamesGivenNamesDateofBirth(Format:DD-MMM-YYYY)PlaceofBirthCityState/ProvinceCountry/RegionIsyourfatherstillliving?(yes)(no)CurrentAddressStreetAddress(Line1)StreetAddress(Line2)*OptionalCityState/ProvincePostalZone/ZIPCodeCountry/RegionMotherSurnamesatBirthGivenNamesDateofBirth(Format:DD-MMM-YYYY)CityState/ProvinceCountry/RegionIsyourmotherstillliving?(yes)(no)Isyourmother'saddressthesameasyourfather's?(yes)(no)CurrentAddressStreetAddress(Line1)StreetAddress(Line2)*OptionalCityState/ProvincePostalZone/ZIPCodeCountry/RegionFamilyInformation:PreviousSpouseNOTE:Pleaseprovidethefollowinginformationonallofyourpreviousspouses,includingthosedeceased.Doyouhaveanypreviousspouses?(yes)(no)FamilyInformation:ChildrenDoyouhaveanychildren?(yes)(no)PreviousU.S.TravelInformationHaveyoueverbeenintheU.S.?(yes)(no)HaveyoueverbeenissuedaU.S.Visa?*yes)(no)HaveyoueverbeenrefusedaU.S.Visa,beenrefusedadmissiontotheUnitedStates,orwithdrawnyourapplicationforadmissionattheportofentry?(yes)(no)PresentWork/Education/TrainingInformationPrimaryOccupationPresentEmployerorSchoolNamePresentEmployerorSchooladdress:StreetAddress(Line1)StreetAddress(Line2)*OptionalCityState/ProvincePostalZone/ZIPCodeCountry/RegionDoyouhaveotheroccupations?(yes)(no)nwhichoccupationdoyouintendtoworkintheU.S.?PreviousWork/Education/TrainingInformationWereyoupreviouslyemployed?(yes)(no)Haveyouattendedanyeducationalinstitutionsatasecondarylevelorabove?(yes)(no)AdditionalWork/Education/TrainingInformationHaveyoueverservedinthemilitary?(yes)(no)Haveyoubelongedto,contributedto,orworkedforanyprofessional,social,orcharitableorganization?(yes)(no)Doyouhaveanyspecializedskillsortraining,suchasfirearms,explosives,nuclear,biological,orc...
