DV 2011 Diversity Lottery US Visa Application Form submission

DV-2011 APPLICANT INFORMATION FORM

*FULL NAME :

(First Name)

(Middle name)

(Last/Family Name)

*EMAIL ADDRESS :

Please make sure you spell correctly your email address. DO NOT use www. in front of your email address, because the form will not be submited correctly.

*DATE OF BIRTH :

(Day)

(Month)

(Year)

*PLACE OF BIRTH :

(City/Village)

(County/Region/State)

*COUNTRY OF BIRTH:

(The name of the country should be that which is currently in use for the place where you were born.)

*GENDER:

*MARITAL STATUS ?

*HOW MANY CHILDREN UNDER 21 DO YOU HAVE :

* HOW MANY CHILDREN UNDER 21 UNMARRIED DO YOU HAVE:

(WHICH DO NOT HAVE US CITIZENSHIP)

COUNTRY OF ELIGIBILITY :

(Your country of eligibility will normally be the same as your country of birth. Your country of eligibility is not related to where you live. If you were born in a country that is not eligible for the DV program, please review the instructions to see if there is another option for country of chargeability available for you. )

*WHAT IS THE HIGHEST LEVEL OF EDUCATION YOU HAVE ACHIEVED, AS OF TODAY?

*ENTRY PHOTOGRAPH:

Please attach your photo in .jpg or .gif format. Here is an example: CLICK FOR PHOTO EXAMPLE

*MAILING ADDRESS:

Address Line 1:

Address Line 2:

City/Town:

Province/State:

Postal Code/Zip Code:

Country:

DV-2011 Diversity Visa Lottery

Apply now for the DV-2011 Visa Lottery

DV-2011 APPLICANT INFORMATION FORM