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

REVIEW YOUR APPLICATION

Please review all information for accuracy before submitting your application. If information is inaccurate, select the "Edit" option in the top right corner of the application review. Select "CONFIRM & CONTINUE" if/when all information is correct.

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Family Name
...
First (Given) Name
...
Passport Number
...
Issuing Country
...
Issuance Date
...
Expiration Date
...
Country of Citizenship / Nationality
...
National Identification Number
...
Personal Identification Number
...
Sex
...
Date of Birth
...
City of Birth
...
Country of Birth
...

Other Citizenship/Nationality

Are you now, a citizen or national of any other country? ... Have you ever been a citizen or national of any other country? ...
E-mail Address
example@email.com
Confirm E-mail Address
example@email.com
Edit
Are you known by any other names or aliases? ...
Have you ever been issued a passport or national identity card for travel by any other country? ...

YOUR CONTACT INFORMATION

Address Line 1
...
Address Line 2
...
Apartment Number
...
City
...
State/Province/Region
...
Country
...
Telephone Type
...
Country Code
...
Phone Number
...

GE/NEXUS/SENTRI MEMBERSHIP

Are you a member of the CBP Global Entry/NEXUS/SENTRI Program? ...

PARENTS

Family Name
...
First (Given) Name
...
Family Name
...
First (Given) Name
...

EMPLOYMENT INFORMATION

Do you have a current or previous employer? ...

Edit

Is your travel to the US occurring in transit to another country? ...

EMERGENCY CONTACT INFORMATION IN OR OUT OF THE U.S.

Family Name
...
First (Given) Name
...
E-mail Address
...
Country Code
...
Phone Number
...
Edit

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? ...

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