U.S. Visa Eligibility Form
Complete this form to determine your basic eligibility for a U.S. visa. Answer all questions accurately to help us assess your application.
Full Name
*
First Name
Last Name
Date of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Country of Citizenship
*
Please Select
United States
Canada
Mexico
United Kingdom
India
China
Philippines
Australia
Germany
Other
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Have you ever visited the United States before?
*
Yes
No
Purpose of Your Visit to the U.S.
*
Tourism
Business
Study
Transit
Family Visit
Other
Intended Date of Arrival in the U.S.
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Have you ever been refused a U.S. visa or entry to the United States?
*
Yes
No
Have you ever been convicted of a crime or immigration violation in any country?
*
Yes
No
Current Employment Status
*
Please Select
Employed
Self-Employed
Unemployed
Student
Retired
Other
Do you have immediate family members currently living in the U.S.?
*
Yes
No
Check Eligibility
Should be Empty: