1
Disclaimers
2
Applicant Information
3
Personal Information
4
Travel Information
5
Eligibility Questions
6
Review Application
7
Pay

ELIGIBILITY QUESTIONS

Please provide all responses in English.
Required fields are indicated by an asterisk *.

1) Do you have a physical or mental disorder; or are you a drug abuser or addict; or do you currently have any of the following diseases (communicable diseases are specified pursuant to section 361(b) of the Public Health Service Act): *

  • Cholera
  • Diphtheria
  • Tuberculosis, infectious
  • Plague
  • Smallpox
  • Yellow Fever
  • Viral Hemorrhagic Fevers, including Ebola, Lassa, Marburg, Crimean-Congo
  • Severe acute respiratory illnesses capable of transmission to other persons and likely to cause mortality.

2) Have you ever been arrested or convicted for a crime that resulted in serious damage to property, or serious harm to another person or government authority? *

3) Have you ever violated any law related to possessing, using, or distributing illegal drugs? *

4) Do you seek to engage in or have you ever engaged in terrorist activities, espionage, sabotage, or genocide? *

5) Have you ever committed fraud or misrepresented yourself or others to obtain, or assist others to obtain, a visa or entry into the United States? *

6) Are you currently seeking employment in the United States or were you previously employed in the United States without prior permission from the U.S. government? *

7) Have you ever been denied a U.S. visa you applied for with your current or previous passport, or have you ever been refused admission to the United States or withdrawn your application for admission at a U.S. port of entry? *

8) Have you ever stayed in the United States longer than the admission period granted to you by the U.S. government? *

9) Have you traveled to, or been present in Cuba, Iran, Iraq, Libya, North Korea, Somalia, Sudan, Syria or Yemen on or after March 1, 2011? *

WAIVER OF RIGHTS

I have read and understand that I hereby waive for the duration of my travel authorization obtained via ESTA any rights to review or appeal of a U.S. Customs and Border Protection Officer's determination as to my admissibility, or to contest, other than on the basis of an application for asylum, any removal action arising from an application for admission under the Visa Waiver Program.

In addition to the above waiver, as a condition of each admission into the United States under the Visa Waiver Program, I agree that the submission of biometric identifiers (including fingerprints and photographs) during processing upon arrival in the United States shall reaffirm my waiver of any rights to review or appeal of a U.S. Customs and Border Protection Officer's determination as to my admissibility, or to contest, other than on the basis of an application for asylum, any removal action arising from an application for admission under the Visa Waiver Program.

CERTIFICATION: *

THIRD PARTIES ONLY:

Step 5 of 7

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