Online Nonimmigrant Visa Application (DS-160) Application ID AA00EKMHZJ

Home Address

Street Address (Line 1)

Street Address (Line 2) *Optional

City

State/Province
Does Not Apply

Postal Zone/ZIP Code
Does Not Apply

Country/Region
- Select One - AFGHANISTAN ALBANIA ALGERIA AMERICAN SAMOA ANDORRA ANGOLA ANGUILLA ANTIGUA AND BARBUDA ARGENTINA ARMENIA ARUBA AUSTRALIA AUSTRIA AZERBAIJAN BAHAMAS BAHRAIN BANGLADESH BARBADOS BELARUS BELGIUM BELIZE BENIN BERMUDA BHUTAN BOLIVIA BONAIRE BOSNIA-HERZEGOVINA BOTSWANA BRAZIL BRITISH INDIAN OCEAN TERRITORY BRUNEI BULGARIA BURKINA FASO BURMA BURUNDI CAMBODIA CAMEROON CANADA CABO VERDE CAYMAN ISLANDS CENTRAL AFRICAN REPUBLIC CHAD CHILE CHINA CHRISTMAS ISLAND COCOS KEELING ISLANDS COLOMBIA COMOROS CONGO, DEMOCRATIC REPUBLIC OF THE CONGO, REPUBLIC OF THE COOK ISLANDS COSTA RICA COTE D`IVOIRE CROATIA CUBA CURACAO CYPRUS CZECH REPUBLIC DENMARK DJIBOUTI DOMINICA DOMINICAN REPUBLIC ECUADOR EGYPT EL SALVADOR EQUATORIAL GUINEA ERITREA ESTONIA ESWATINI ETHIOPIA FALKLAND ISLANDS FAROE ISLANDS FIJI FINLAND FRANCE FRENCH GUIANA FRENCH POLYNESIA FRENCH SOUTHERN AND ANTARCTIC TERRITORIES GABON GAMBIA, THE GAZA STRIP GEORGIA GERMANY GHANA GIBRALTAR GREECE GREENLAND GRENADA GUADELOUPE GUAM GUATEMALA GUINEA GUINEA - BISSAU GUYANA HAITI HEARD AND MCDONALD ISLANDS HOLY SEE (VATICAN CITY) HONDURAS HONG KONG HOWLAND ISLAND HUNGARY ICELAND INDIA INDONESIA IRAN IRAQ IRELAND ISRAEL ITALY JAMAICA JAPAN JERUSALEM JORDAN KAZAKHSTAN KENYA KIRIBATI KOREA, DEMOCRATIC REPUBLIC OF (NORTH) KOREA, REPUBLIC OF (SOUTH) KOSOVO KUWAIT KYRGYZSTAN LAOS LATVIA LEBANON LESOTHO LIBERIA LIBYA LIECHTENSTEIN LITHUANIA LUXEMBOURG MACAU MACEDONIA, NORTH MADAGASCAR MALAWI MALAYSIA MALDEN ISLAND MALDIVES MALI MALTA MARSHALL ISLANDS MARTINIQUE MAURITANIA MAURITIUS MAYOTTE MEXICO MICRONESIA MIDWAY ISLANDS MOLDOVA MONACO MONGOLIA MONTENEGRO MONTSERRAT MOROCCO MOZAMBIQUE NAMIBIA NAURU NEPAL NETHERLANDS NEW CALEDONIA NEW ZEALAND NICARAGUA NIGER NIGERIA NIUE NORFOLK ISLAND NORTH MARIANA ISLANDS NORTHERN IRELAND NORWAY OMAN PAKISTAN PALAU PALMYRA ATOLL PANAMA PAPUA NEW GUINEA PARAGUAY PERU PHILIPPINES PITCAIRN ISLANDS POLAND PORTUGAL PUERTO RICO QATAR REUNION ROMANIA RUSSIA RWANDA SABA ISLAND SAINT MARTIN SAMOA SAN MARINO SAO TOME AND PRINCIPE SAUDI ARABIA SENEGAL SERBIA SEYCHELLES SIERRA LEONE SINGAPORE SINT MAARTEN SLOVAKIA SLOVENIA SOLOMON ISLANDS SOMALIA SOUTH AFRICA SOUTH GEORGIA AND THE SOUTH SANDWICH ISLAND SOUTH SUDAN SPAIN SRI LANKA ST. EUSTATIUS ST. HELENA ST. KITTS AND NEVIS ST. LUCIA ST. PIERRE AND MIQUELON ST. VINCENT AND THE GRENADINES SUDAN SURINAME SVALBARD SWEDEN SWITZERLAND SYRIA TAIWAN TAJIKISTAN TANZANIA THAILAND TIMOR-LESTE TOGO TOKELAU TONGA TRINIDAD AND TOBAGO TUNISIA TURKEY TURKMENISTAN TURKS AND CAICOS ISLANDS TUVALU UGANDA UKRAINE UNITED ARAB EMIRATES UNITED KINGDOM UNITED STATES OF AMERICA URUGUAY UZBEKISTAN VANUATU VENEZUELA VIETNAM VIRGIN ISLANDS (U.S.) VIRGIN ISLANDS, BRITISH WAKE ISLAND WALLIS AND FUTUNA ISLANDS WEST BANK WESTERN SAHARA YEMEN ZAMBIA ZIMBABWE

Mailing Address

Is your Mailing Address the same as your Home Address?

Yes

No

Phone

Primary Phone Number

Secondary Phone Number
Does Not Apply

Work Phone Number
Does Not Apply

Help: 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.

Have you used any other phone numbers in the last five years?

Yes

No

Email Address

Email Address

(e.g., emailaddress@example.com)

Help: 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?

Yes

No