U.S. Department of State · DS-160 · Work, study & frequent travel

Complex Completed DS-160 Form

417responses20sections~75 minto fillWork, study & renewals
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These are completed examples — real questions with sample answers, shown for reference.
§1

Personal Information - Part 1

19 responses

Surnames

Enter all surnames as listed in your passport. If only one name is listed in your passport, enter that Surname.

Given Names

If your passport does not include a given name, please enter 'FNU' in Given Names.

Full Name in Native Alphabet

If your passport does not include a given name, please enter 'FNU' in Given Names.

NA Does Not Apply/Technology Not Available

Other Names

Other names used include your maiden name, religious name, professional name, or any other names which you are known by or have been known by in the past.

Have you ever used other names (i.e., maiden, religious, professional, alias, etc.)?required
Provide the following information:

Telecode

Telecodes are 4 digit code numbers that represent characters in some non-Roman alphabet names.

Do you have a telecode that represents your name?required

Telecode Name

If you only have telecode surnames to enter, enter the same given names as above. Conversely, if you only have telecode given names to enter, enter the same surname as above.

Provide the following information:

Sex

Please select MALE or FEMALE

Date of Birth

If day or month is unknown, enter as shown in passport.

Date of Birthrequired
08 JUN 1999
NA Does Not Apply

Country/Region

Select the name that is currently in use for the place where you were born.

§2

Personal Information - Part 2

17 responses
Do you hold or have you held any nationality other than the one indicated above on nationality?required
Other Nationalities

Other Nationalities

Enter all nationalities you currently hold and all nationalities you have previously held, regardless of whether you have formally and/or legally relinquished the nationality. If the country where you previously held nationality is no longer a political entity or country, select the nationality that corresponds with the name of the country that is currently used for that location.

Do you hold a passport for the other country/region of origin (nationality) above?required

Passport Number

Enter the passport number exactly as it appears on the passport.

Other Nationalities

Enter all nationalities you currently hold and all nationalities you have previously held, regardless of whether you have formally and/or legally relinquished the nationality. If the country where you previously held nationality is no longer a political entity or country, select the nationality that corresponds with the name of the country that is currently used for that location.

Do you hold a passport for the other country/region of origin (nationality) above?required

Passport Number

Enter the passport number exactly as it appears on the passport.

Other Nationalities

Enter all nationalities you currently hold and all nationalities you have previously held, regardless of whether you have formally and/or legally relinquished the nationality. If the country where you previously held nationality is no longer a political entity or country, select the nationality that corresponds with the name of the country that is currently used for that location.

Do you hold a passport for the other country/region of origin (nationality) above?required

Permanent Resident

Permanent resident means any individual who has been legally granted by a country/region permission to live and work without time limitation in that country/region.

Are you a permanent resident of a country/region other than your country/region of origin (nationality) indicated above?required
Other Permanent Resident Country/Region

Identification Numbers

Your National ID Number is a unique number that your government provides. The U.S. Government provides unique numbers to those who seek employment (Social Security Number) or pay taxes (Taxpayer ID).

NA Does Not Apply
NA Does Not Apply
NA Does Not Apply
§3

Purpose of Visa

21 responses
Purpose of Visit

Petition Number or Application Receipt Number

The receipt number is a 13-character alphanumeric identifier and follows this format: XXX-YY-ZZZ-NNNNN

Have you made specific travel plans?required
Provide a complete itinerary for your travel to the U.S.

Travel Plans

If you are unsure of your Date of Arrival in U.S. or Date of Departure from U.S., please provide an estimate.

Arrival Daterequired
31 JUL 2026
Departure Daterequired
30 AUG 2026
Locations you plan to visit:
Address where you will stay in the U.S.
§4

Travel Companions

8 responses

Traveling with Others

You should answer Yes to this question if you are traveling with family, as part of an organized tour, or as part of a performing group or athletic team. You do not need to list individuals who are traveling with you for the purposes of employment with the same employer.

Are there other persons traveling with you?required
Are you traveling as part of a group or organization?required
Provide the following information for each person traveling with you:
§5

Previous U.S. Travel History

31 responses
Have you ever been in the U.S.?required

Previous U.S. Visits

If you are unsure about when you visited the U.S., please provide a best estimate.

Details on your visit
Provide information on your last U.S. visit:
Date Arrivedrequired
01 JUN 2024
Date Arrivedrequired
02 JUN 2023
Do you or did you ever hold a U.S. Driver's License?required
Provide information on your U.S. Driver's Licenses:
NA Do not know
NA Do not know
NA Do not know
Have you ever been issued a U.S. Visa?required
Previous U.S. Visa
Date Last Visa Was Issuedrequired
01 JUN 2024

Visa Number

Enter the 8-digit number that is displayed in red on the lower right hand side of your visa. If your previous visa was a Border Crossing Card enter the last 12-digit number of the first line of the machine readable zone.

NA Do not know
Are you applying for the same type of visa?required
Are you applying in the same country or location where the visa above was issued, and is this country or location your place of principal of residence?required

Ten-printed

Ten-printed means that you have provided fingerprints for all your fingers, as opposed to having provided only two fingerprints.

Have you been ten-printed?required
Has your U.S. Visa ever been lost or stolen?required
Has your U.S. Visa ever been cancelled or revoked?required
Have you ever been refused a U.S. Visa, or been refused admission to the United States, or withdrawn your application for admission at the port of entry?required
Have you ever been denied travel authorization by the Department of Homeland Security through the Electronic System for Travel Authorization (ESTA)?required
Has anyone ever filed an immigrant petition on your behalf with the United States Citizenship and Immigration Services?required
§6

Address and Phone Details

36 responses
Home Address
NA Does not apply
NA Does not apply

Mailing Address

If your mailing address is different from your home address, please provide your mailing address.

Is your Mailing Address the same as your Home Address?required
Mailing Address
NA Does not apply
NA Does not apply

Phone

You must provide a primary phone number. The primary phone number should be the phone number at which you are most likely to be reached; this could be a land line or a cellular/mobile number. If you have an additional land line or a cellular/mobile number please list that as your secondary phone number.

Phone
NA Does not apply
NA Does not apply
Have you used any other phone numbers in the last five years?required
Provide the following information for each phone number:

Email Address

You must provide an email address. The email address you provide will be used for correspondence purposes. Provide an email address that is secure and to which you have reasonable access.

Have you used any other email addresses in the last five years?required
Social Media
Do you wish to provide information about your presence on any other websites or applications you have used within the last five years to create or share content (photos, videos, status updates, etc.)?required
Provide the following information for each website or application:
§7

Passport Information

19 responses

Passport/Travel Document Number

Enter the information on the travel document you will be using when traveling to the U.S. Your travel document should be a valid, unexpired passport or other valid, unexpired documentation that is sufficient to establish your identity and nationality.

Passport Book Number

The Passport Book Number is commonly called the inventory control number. You may or may not have a Passport Book Number on your passport. The location of the Passport Book Number on your passport may vary depending on the country that issued your passport. Please contact your passport issuing authority if you are unable to determine whether or not your passport contains a Passport Book Number.

NA Does not apply
Where was the Passport/Travel Document Issued?
Issuance Daterequired
02 JUN 2021

Expiration Date

In most cases your passport/Travel Document must have at least six months of validity beyond the date of your visa application and/or your arrival in the United States.

Expiration Daterequired
31 MAY 2031
NA No expiration
Have you ever lost a passport or had one stolen?required
Provide the following information for each lost or stolen passport:
NA Do not know
NA Do not know
NA Do not know
§8

Contact Information

11 responses

Contact Person or Organization in the United States

Your U.S. Point of Contact can be any individual in the U.S. who knows you and can verify, if necessary, your identity. If you do not personally know anyone in the U.S., you may enter the name of the store, company, or organization you plan to visit during your trip.

Contact Person or Organization in the United States

Contact Person

Do Not Know

Organization Name

Do Not Know
Address and Phone Number of Point of Contact
NA Does not apply
§9

Family Information

23 responses
Father's Full Name and Date of Birth
NA Do not know
NA Do not know
Date of Birthrequired
16 JUN 1966
NA Do not know
Is your father in the U.S.?required
Mother's Full Name and Date of Birth
NA Do not know
NA Do not know
Date of Birthrequired
15 JUN 1971
NA Do not know
Is your mother in the U.S.?required

Immediate Relatives

Means fiancé/fiancée, spouse (husband/wife), child (son/daughter), or sibling (brother/sister).

Do you have any immediate relatives, not including parents, in the United States?required
Provide the following information:
§10

Current Occupation

12 responses
Present Work/Education/Training Information
Present Employer or School Information
Present Employer or School Address
NA Does not apply
NA Does not apply
Start Daterequired
02 JUN 2021
NA Does not apply
§11

Previous Occupation

66 responses
Were you previously employed?required
Employer/Employment Information:
Employer Address
NA Does not apply
NA Does not apply
NA Do not know
NA Do not know
Employment Date Fromrequired
02 JUN 2020
Employment Date Torequired
02 JUN 2021
Employer Address
NA Does not apply
NA Does not apply
NA Do not know
NA Do not know
Employment Date Fromrequired
03 JUN 2018
Employment Date Torequired
03 JUN 2019

Level of Education

You must answer Yes to this question if you have ever attended, for any length of time, a high school/secondary school (or its equivalent in your country) or college, university, graduate school, a doctoral program, or a vocational program.

Have you attended any educational institutions at a secondary level or above?required
Provide the following information on the educational institution(s) you have attended.
Address
NA Does not apply
NA Does not apply
Date of Attendance Fromrequired
03 JUN 2017
Date of Attendance Torequired
02 JUN 2021
Address
NA Does not apply
NA Does not apply
Date of Attendance Fromrequired
02 JUN 2021
Date of Attendance Torequired
02 JUN 2022
Address
NA Does not apply
NA Does not apply
Date of Attendance Fromrequired
02 JUN 2022
Date of Attendance Torequired
01 FEB 2026
Address
NA Does not apply
NA Does not apply
Date of Attendance Fromrequired
02 JUN 2023
Date of Attendance Torequired
06 JUN 2025
§12

Additional Occupation Details

36 responses
Do you belong to a clan or tribe?required
Provide a List of Languages You Speak
Have you traveled to any countries/regions within the last five years?required
Provide a List of Countries/Regions Visited
Have you belonged to, contributed to, or worked for any professional, social, or charitable organization?required
Provide a List of Organizations
Do you have any specialized skills or training, such as firearms, explosives, nuclear, biological, or chemical experience?required
Have you ever served in the military?required
Provide the following information:

Name of Country/Region

Please select the current name of the country/region where you performed military service.

Date of Service Fromrequired
04 JUN 2012
Date of Service Torequired
03 JUN 2017

Name of Country/Region

Please select the current name of the country/region where you performed military service.

Date of Service Fromrequired
03 JUN 2018
Date of Service Torequired
02 JUN 2023

Name of Country/Region

Please select the current name of the country/region where you performed military service.

Date of Service Fromrequired
04 JUN 2014
Date of Service Torequired
03 JUN 2019
Have you ever served in, been a member of, or been involved with a paramilitary unit, vigilante unit, rebel group, guerrilla group, or insurgent organization?required
§13

Security Background - Part 1

6 responses
Do you have a communicable disease of public health significance? (Communicable diseases of public significance include chancroid, gonorrhea, granuloma inguinale, infectious leprosy, lymphogranuloma venereum, infectious stage syphilis, active tuberculosis, and other diseases as determined by the Department of Health and Human Services.)required
Do you have a mental or physical disorder that poses or is likely to pose a threat to the safety or welfare of yourself or others?required
Are you or have you ever been a drug abuser or addict?required
§14

Security Background - Part 2

14 responses
Have you ever been arrested or convicted for any offense or crime, even though subject of a pardon, amnesty, or other similar action?required
Have you ever violated, or engaged in a conspiracy to violate, any law relating to controlled substances?required
Are you coming to the United States to engage in prostitution or unlawful commercialized vice or have you been engaged in prostitution or procuring prostitutes within the past 10 years?required
Have you ever been involved in, or do you seek to engage in, money laundering?required
Have you ever committed or conspired to commit a human trafficking offense in the United States or outside the United States?required
Have you ever knowingly aided, abetted, assisted or colluded with an individual who has committed, or conspired to commit a severe human trafficking offense in the United States or outside the United States?required
Are you the spouse, son, or daughter of an individual who has committed or conspired to commit a human trafficking offense in the United States or outside the United States and have you within the last five years, knowingly benefited from the trafficking activities?required
§15

Security Background - Part 3

24 responses
Do you seek to engage in espionage, sabotage, export control violations, or any other illegal activity while in the United States?required
Do you seek to engage in terrorist activities while in the United States or have you ever engaged in terrorist activities?required
Have you ever or do you intend to provide financial assistance or other support to terrorists or terrorist organizations?required
Are you a member or representative of a terrorist organization?required
Are you the spouse, son, or daughter of an individual who has engaged in terrorist activity, including providing financial assistance or other support to terrorists or terrorist organizations, in the last five years?required
Have you ever ordered, incited, committed, assisted, or otherwise participated in genocide?required
Have you ever committed, ordered, incited, assisted, or otherwise participated in torture?required
Have you committed, ordered, incited, assisted, or otherwise participated in extrajudicial killings, political killings, or other acts of violence?required
Have you ever engaged in the recruitment or the use of child soldiers?required
Have you, while serving as a government official, been responsible for or directly carried out, at any time, particularly severe violations of religious freedom?required
Have you ever been directly involved in the establishment or enforcement of population controls forcing a woman to undergo an abortion against her free choice or a man or a woman to undergo sterilization against his or her free will?required
Have you ever been directly involved in the coercive transplantation of human organs or bodily tissue?required
§16

Security Background - Part 4

10 responses
Have you ever been the subject of a removal or deportation hearing?required
Have you ever sought to obtain or assist others to obtain a visa, entry into the United States, or any other United States immigration benefit by fraud or willful misrepresentation or other unlawful means?required
Have you failed to attend a hearing on removability or inadmissibility within the last five years?required
Have you ever been unlawfully present, overstayed the amount of time granted by an immigration official or otherwise violated the terms of a U.S. visa?required
Have you ever been removed or deported from any country?required
§17

Security Background - Part 5

10 responses
Have you ever withheld custody of a U.S. citizen child outside the United States from a person granted legal custody by a U.S. court?required
Have you voted in the United States in violation of any law or regulation?required
Have you ever renounced United States citizenship for the purposes of avoiding taxation?required
Are you a former exchange visitor (J) who has not yet fulfilled the two-year foreign residence requirement?required
Have you attended a public elementary school on student (F) status or a public secondary school after November 30, 1996 without reimbursing the school?required
§18

Student Visa Details - Part 1

38 responses
Additional Point of Contact Information

List at least 2 contacts in your country of residence who can verify your information. Do not list immediate family members or other relatives.

NA Does Not Apply
NA Does Not Apply
NA Does Not Apply
NA Does Not Apply
NA Does Not Apply
NA Does Not Apply
NA Does Not Apply
NA Does Not Apply
NA Does Not Apply
NA Does Not Apply
NA Does Not Apply
NA Does Not Apply
NA Does Not Apply
NA Does Not Apply
NA Does Not Apply
NA Does Not Apply
§19

Student Visa Details - Part 2

7 responses
Provide additional information below:

Course Study

§20

Temporary Visa Information

9 responses
Where Do You Intend to Work?

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