NVC QUESTIONNAIRE: DS260

Please complete all the information requested. If you need extra space, please use an
additional page

1-Name: Surname(s): First name(s): Middle name(s):

2-Any Other names Used (maiden name, religious name, etc.):

3-Sex:

4-Current marital status (single, married, widowed, divorced, legally separated):

5-Date of birth: Day Month Year

6-Town/City of birth:

7-State/Province of birth, if applicable:

8-Country of birth:

9-Country of origin (Nationality):

10-Travel document type (passport or other):

Travel document ID#:

Country that issued document:

Issuance date: Day Month Year

Expiration date: Day Month Year

11-Do you hold or have you held any nationality other than the one you indicated above?

Yes No

If yes, what country/countries:

Do you hold a passport from that country?

12-Current address:

Street name and number:

Town/City:

State/Province, if applicable:

Postal code, if applicable:

Country:

Date you started living at this address: Month Year

If you moved away from this address and then returned, put the month/year since you
returned to this address.

13-Have you lived at other addresses since age 16? This includes all addresses including in other
countries where you were working or addresses where you lived when you were going to
university. Yes No

If yes, please list all previous addresses since age 16. If you need more space, please use a separate
page. Start with the most recent previous address. You can repeat addresses if you moved away
and returned to the same address.

14-Previous address (1):

Street name and number:

Town/City:

State/Province, if applicable

Postal code, if applicable:

Country:

From: Month Year

To: Month Year

15-Previous address (2):

2
 Street name and number:

Town/City:

State/Province, if applicable

Postal code, if applicable:

Country:

From: Month Year

To: Month Year

16-Previous address (3):

Street name and number:

Town/City:

State/Province, if applicable

Postal code, if applicable:

Country:

From: Month Year

To: Month Year

17-Primary phone number:

18-Secondary phone number, if applicable

19-Work phone number, if applicable

20-Other phone numbers used during the last 5 years:

21-Email address:

22-Other email addresses in the last 5 years:

23-Social media provider or platform used in the last 5 years ([Link]; Douban; Facebook; Flickr;
Google+; Instagram; LinkedIn; Myspace; Pinterest; QZone(QQ); Reddit; Sina Weibo; Tencent
Weibo; Tumblr; Twitter; Twoo; Vine; Vkontakte(VK); Youku; Youtube).

3
 Add more on additional page if needed:

Platform: User name:

Platform: User name:

Platform: User name:

24-Other social media used in last 5 years to create or share content (photos, videos, etc.)

Social media: User name:

25-Is your mailing address the same as your present address? Yes No

If no, then give the following:

Street name and number:

Town/City:

State/Province, if applicable

Postal code, if applicable:

Country:

26-Do you have an address in the United States where you intend to live? Yes No

If yes:

Name of person currently living at that address, if applicable:

Street name and number:

Town/City:

State:

Zip code:

Phone number:

27-Your father’s information:

Surname(s):

First name(s): Middle name(s):

4
 Date of birth: Day Month Year

Town/City of birth:

State/Province of birth, if applicable:

Country of birth:

Is your father still living? Yes No

If no, give year of death:

If yes, give address:

Street name and number:

Town/City:

State/Province, if applicable:

Postal code:

Country:

28-Your mother’s information:

Surname(s) at birth:

First name(s): Middle name(s):

Date of birth: Day Month Year

Town/City of birth:

State/Province of birth, if applicable:

Country of birth:

Is your mother still living? Yes No

If no, give year of death

If yes give address:

Street name and number:

Town/City:

5
 State or Province, if applicable:

Postal code:

Country:

29-Your spouse’s information, if married. If not married, skip to #30:

Spouse’s surname(s):

First name(s): Middle name(s):

Spouse’s Date of birth: Day Month Year

Spouse’s City of birth:

Spouse’s State/Province of birth, if applicable:

Spouse’s Country of birth:

Does your spouse live with you? Yes No

If no, give address:

Street name and number:

City:

State/Province, if applicable:

Postal code:

Country:

Spouse’s field of work or study, if applicable (such as Business, Education, Health, Student,
Unemployed, etc.):

Date of marriage: Day Month Year

Location of marriage:

City:

State or Province:

Country:

6
 Is your spouse immigrating to the U.S. with you? Yes No

If no, is your spouse immigrating later to join you?

Does your spouse live with you? Yes No

If no, give address:

Street name and number:

City:

State/Province, if applicable:

Postal code:

Country:

30-Do you have previous spouses? Yes No

If no, skip to #31.

If yes, please give the following information:

Number of previous spouses:

For each of the previous spouses give the following information:

Surname(s):

First name(s): Middle name(s):

Date of birth: Day Month Year

Date of marriage: Month, day, year

Date marriage ended: month, day, and year

How was your marriage terminated?

Country where marriage was terminated:

31-Do you have children? Yes No

If no, skip to #35.

If yes, how many?

7
For each child give the following information. If you need more room, use an extra page.

32. Child 1

Surname(s):

First name(s): Middle name(s):

Date of birth: Day Month Year

City of birth:

State/Province of birth, if applicable:

Country of birth:

Does this child live with you? Yes No

If no, provide complete address below:

Street name and number:

City:

State/Province, if applicable:

Country:

Postal code:

Country:

Is this child immigrating with you? Yes No

If no, is this child immigrating later to join you? Yes No

33. Child 2

Surname(s):

First name(s): Middle name(s):

Date of birth: Day Month Year

City of birth:

State/Province of birth, if applicable:

8
 Country of birth:

Does this child live with you? Yes No

If no, provide complete address below:

Street name and number:

City:

State/Province, if applicable:

Postal code:

Country:

Is this child immigrating with you? Yes No

If no, is this child immigrating later to join you? Yes No

34. Child 3

Surname(s):

First name(s): Middle name(s):

Date of birth: Day Month Year

City of birth:

State/Province of birth:

Country of birth:

Does this child live with you? Yes No

If no, provide complete address below:

Street name and number:

City:

State/Province, if applicable:

Postal code:

Country:

9
 Is this child immigrating with you? Yes No

If no, is this child immigrating later to join you? Yes No

35-Have you ever been in the U.S? Yes No

If no, skip to #36.

If yes, provide the following information about your last five visits to the U.S.:

Visit 1:

Date arrived: Day Month Year

Length of stay:

Visit 2:

Date arrived: Day Month Year

Length of stay:

Visit 3:

Date arrived: Day Month Year

Length of stay:

Visit 4:

Date arrived: Day Month Year

Length of stay:

Visit 5:

Date arrived: Day Month Year

Length of stay:

36-Have you ever been issued a U.S. visa? Yes No

If no, skip to #37.

If yes, provide the following information about your most recent visa:

Date visa was issued: Day Month Year

10
 U.S. visa classification (B-2, F-1, etc.):

U.S. visa number (red number on the visa):

Have any of your U.S. visas ever been lost or stolen? Yes No

If yes, provide the following:

The year the visa was lost or stolen, and a brief explanation

Have any of your visas have been cancelled or revoked? Yes No

If yes, provide the following:

Year the visa was cancelled and a brief explanation:

37-Have you ever been refused a visa or refused admission to the U.S.? Yes No

If yes, explain.

38-Current field of work or study, if applicable (such as Business, Education, Health, or Student). Or
say Unemployed.

39-Present employer or school name, if applicable:

Street name and number:

Town/City:

State/ Province, if applicable:

Postal code:

Country:

40-Do you have any other work or study at this time? Yes No

If yes, provide the following information for each different occupation:

Field of work or study:

Other employer or school name:

Street name and number:

Town/City:

11
 State/Province, if applicable:

Country:

41-Were you previously employed? Yes No

If no, skip to #43.

If yes, provide the following information for your employment during the last 10 years. Use
extra pages if necessary.

Employer’s name:

Street name and number:

Town/City:

State/ Province, if applicable:

Postal code:

Country:

Telephone number:

Job Title:

Supervisor’s surname(s):

Supervisor’s name:

From: Day Month Year

To: Day Month Year

42-Have you attended any educational institutions at a secondary level or above (high school,
university)? Yes No

If no, skip to #43.

If yes, number of educational institutions attended:

Name of institution (1):

Street name and number:

12
 Town/City:

State/ Province, if applicable:

Postal code:

Country:

Field of study (for high school put either “Academic” or “Vocational):

Degree received (high school diploma, Bachelor’s, etc.):

Dates of attendance:

From: Day Month Year

To: Day Month Year

Name of institution (2):

Street name and number:

Town/City:

State/ Province, if applicable:

Postal code:

Country:

Field of study (for high school put either “Academic” or “Vocational):

Degree received (high school diploma, Bachelor’s, etc.):

Dates of attendance:

From: Day Month Year

To: Day Month Year

If you attended more than two educational institutions at a secondary level, please provide the
same information you provided for institutions 1 and 2 on another page

43-Have you traveled to a country other than the U.S. in the past five years? Yes No

If “yes” list all the countries visited:

13
44-Have you ever served in the military? Yes No

If yes, provide the following information:

Name of country:

Branch of service:

Rank/Position:

Military specialty:

Dates of service:

From: Day Month Year

To: Day Month Year

Specify location:

45-Have you belonged to, contributed to, or worked for any professional, social, or charitable
organization? Yes No

If yes, provide names of organizations:

46-Do you have any specialized skills or training, including firearms, explosives, nuclear, biological,
or chemical experience? Yes No

If yes, please explain:

47-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? Yes No

If yes, explain:

48-List all languages you speak and/or read:

49-Have you ever applied for a U.S. Social Security Number? Yes No

14
 If yes, provide your Social Security Number:
If no,
Do you authorize disclosure of information from this form to the Department of Homeland
Security, the Social Security Administration, and such other U.S. Government agencies as
may be required for the purposes of assigning you a social security number (SSN) and
issuing you a Social Security card and do you authorize the Social Security Administration to
share your SSN with the Department of Homeland Security?
Yes No

Complete questionnaire and return to: carol@[Link].

Thank you!

15