Then, enter the duration of stay in each location. Person s named in 14 and 29 who will accompany you to the United States now. Person s named in 14 and 29 who will follow you to the United States at a later date. If Yes, enter the military service's branch, including your date of service, rank or position, and military specialty or occupation. Enter the dates and address of your previous visits or residence in the U. Then, enter the type of visa and your A-number. Read and answer the questions in this section.
Your answers will be a determining factor in whether or not you are eligible to receive a visa. Mark Yes, if you are an alien who has a communicable disease of public health significance; who has failed to present documentation of having received vaccinations in accordance with the U.
Mark Yes, if you are an alien convicted of, or who admits having committed, a crime involving moral turpitude or violation of any law relating to a controlled substance or who is the spouse, son or daughter of such a trafficker who knowingly has benefited from the trafficking activities in the past five years; who has been convicted of 2 or more offenses for which the aggregate sentences were 5 years or more; who is coming to the U.
Mark Yes, if you are an alien who seeks to enter the U. Secretary of State. Mark Yes, if you are an alien who is likely to become a public charge. Mark No, if not. Mark Yes, if you are an alien who seeks to enter to perform skilled or unskilled labor who has not been certified by the Secretary of Labor; who is a graduate of a foreign medical school seeking to perform medical services who has not passed the NBME exam or its equivalent; or who is a health care worker seeking to perform such work without a certificate from the CGFNS or an equivalent approved independent credentialing organization.
Mark Yes, if you are an alien who failed to attend a hearing on deportation or inadmissibility within the last 5 years; who seeks or has sought a visa, entry into the United States, or any immigration benefit by fraud or misrepresentation; who knowingly assisted any other alien to enter or try to enter the United States in violation of law; who, after November 30, , attended in student F visa status a U.
Mark Yes, if you are an alien who is permanently ineligible for U. Mark Yes, if you are an alien who was previously ordered removed within the last 5 years or been ordered removed twice within the last 20 years; who was previously unlawfully present and ordered removed within the last 10 years, or ordered removed twice within the last 20 years; who was convicted of an aggravated felony and ordered removed; who was previously unlawfully present in the United States for more than days but less than one year who voluntarily departed within the last 3 years; or who was unlawfully present for more than one year or an aggregate of one year within the last 10 years.
Mark Yes, if you are an alien who is coming to the U. Mark Yes, if you are an alien who is a former exchange visitor who has not fulfilled the 2-year foreign residence requirement. Mark Yes, if you are an alien determined by the Attorney General to have knowingly made a frivolous asylum application.
Mark Yes, if you are an alien who has ordered, carried out or materially assisted in extrajudicial and political killings and other acts of violence against the Haitian people; who has directly or indirectly assisted or supported any of the groups in Colombia known as FARC, ELN, or AUC; who through abuse of a governmental or political position has converted for personal gain, confiscated or expropriated property in Cuba, a claim to which is owned by a national of the U. Mark Yes, if you have been charged, arrested, or convicted of any offense or crime.
Then, provide an explanation. Have you ever been refused admission to the United States at a port-of-entry? Mark Yes, if you have been refused admission to the United States at a port-of-entry. Then, enter the SSN. If so, mark Yes if you like to receive a replacement card. Mark Yes, if you were assisted in completing DS Then, enter the name, address, and your relationship with the assistant. If you are migrating with your family, each member, regardless of age, must accomplish Form DS Make sure that all information entered on the form is factual and accurate.
Upon accomplishing the Form DS, you may submit it to the nearest U. Embassy or Consulate to process your visa application. Keywords: ds ds. All Rights Reserved. You do not have to supply this information unless this. Send Visa Applications to your nearest U. S Embassy or Consulate.
Address If different from your own. List below all places you have lived for at least six months since reaching the age of 16, including places in your country of nationality. City or Town Province Country. Person s named in 14 and 29 who will follow you to the United States at a later date.
Person s named in 14 and 29 who will accompany you to the United States now. List below all employment for the last ten years.
In what occupation do you intend to work in the United States? List below all educational institutions attended. List dates of all previous visits to or residence in the United States.
If never, write "never" Give type of visa status, if known. Dates of Service mm-dd-yyyy. The information asked for on this form is requested pursuant to Section of the Immigration and Nationality Act. The U. Department of State uses the facts you provide. Individuals who fail to submit this form or who do not provide all the requested. If you are issued an immigrant visa and are subsequently admitted to the United States as an immigrant, the Department. Signature of Applicant Date mm-dd-yyyy.
First Name Middle Name. The fee should be paid in United States. Even if you. An alien convicted of, or who admits having committed, a crime involving moral turpitude or violation of any law relating to a. An alien who seeks to enter the United States to engage in espionage, sabotage, export control violations, terrorist activities,.
Communist or other totalitarian party; who participated, engaged or ordered genocide, torture, or extrajudicial killings; or who. Secretary of State. An alien who is likely to become a public charge. An alien who seeks to enter for the purpose of performing skilled or unskilled labor who has not been certified by the.
Secretary of Labor; who is a graduate of a foreign medical school seeking to perform medical services who has not passed. CGFNS or from an equivalent approved independent credentialing organization.
Date of Marriage mm-dd-yyyy. Marital Status 8. Other Names Used or Aliases If married woman, give maiden name. Instructions: Complete one copy of this form for yourself and each member of your family, regardless of age, who will immigrate with you. If there is insufficient room on the form, answer on a. Attach any additional sheets to this form.
Nationality If dual national,. Date of Birth mm-dd-yyyy 5. Age 6. Telephone Number Office. Including my present marriage, I have been married times. Place of Birth Current Address Mother's Date of Birth. First Name Middle Name Father's Family Name. Father's Date of Birth.
Warning: Any false statement or concealment of a material fact may result in your permanent exclusion from the United States.
This form DS Part I is the first of two parts. You do not have to supply this information unless this. Please do not send Visa Applications to this address. Send Visa Applications to your nearest U. S Embassy or Consulate.
Address If different from your own. List below all places you have lived for at least six months since reaching the age of 16, including places in your country of nationality.
City or Town Province Country. Person s named in 14 and 29 who will follow you to the United States at a later date. Person s named in 14 and 29 who will accompany you to the United States now.
List below all employment for the last ten years. In what occupation do you intend to work in the United States?
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