Email

City and Country of Birth

Citizenship(s)

Marital Status

Preferred Language(s)

Other Countries Where You Have Lived (5+ months)

Do you have a specific visa or program in mind?

Have you ever applied for a visa or immigration to another country? If yes, provide details (country, type, year, outcome)

Have you ever overstayed a visa, been denied entry, or deported? If yes, provide details:

Do you currently have legal status in any country besides your country of citizenship? If yes, provide type of status and expiration:

Do you hold any current visas or permanent resident status? If yes, list countries and visa types:

Spouse/Partner’s Name and Citizenship(s)

Children’s Full Names, Dates of Birth, and Nationalities

Are any family members currently citizens or residents of the destination country? If yes, explain:

Highest Level of Education Completed

Institution Name, Location, and Degree

Current Occupation / Job Title

Employer Name and Location

Do you currently have employment, business, or any other full time or part time work in the US? If yes, please explain.

Do you have work authorization in the US?

Work History (last 5 years or more)

Include country, job title, and dates

Have you ever been charged or convicted of a crime in any country?

If yes, provide brief details:

Do you have any serious health conditions that require ongoing treatment?

If yes, explain:

Have you ever claimed asylum or refugee protection?

If yes, when and where:

Do you have a job offer, school acceptance letter, or sponsorship letter?

If yes, describe:

Any additional facts or concerns you would like us to know?

US Immigration Assistance Form