DS-230/DS-260 QUESTIONNAIRE FOR CONSULAR PROCESSING

Personal Information

1. Full Name: _________________    ________________    ________________
        (Family Name)                   (First Name)                Middle Name

2. Other names(s) used:     a. Maiden Name: __________________________________________ 
 
            b. Name(s) used from prior marriages: _________________________

3. Date of birth (month/day/year): ________________________________

4. Place of birth (city/state/country): ______________________________

5. Nationality: _____________      Gender ____________      Alien Number ___________________

6. Marital Status: ________________ Number of marriages including the current one: _______

7. Given the permanent address in the United States where you intend to live (street/city/state/zip code):
_______________________________________________________________

8. Current occupation: _______________    Social Security Number: _____________________

9. Current address (street/city/state/zip code/country):
_______________________________________________________________

10. Information about your spouse

    Full Name: ________________       ___________________     ______________
                                  (Family Name)               (First Name)                       (Middle Name)
    Date of Birth (month/day/year): _____________ 
    Place of Birth (City/State/Country): ____________________
    Home Address (Street/City/State/Zip/Country): ________________________________________
    Occupation: _______________            Date of Marriage (month/day/year): __________________

11. Information about your father

    Full Name: ________________       ___________________     ______________
                                  (Family Name)               (First Name)                       (Middle Name)
    Date of Birth (month/day/year): _____________ 
    Place of Birth (City/State/Country): ____________________
    Home Address (Street/City/State/Zip/Country): ________________________________________

12. Information about your mother
    Full Name: ________________       ___________________     ______________
                                  (Family Name)               (First Name)                       (Middle Name)
    Date of Birth (month/day/year): _____________ 
    Place of Birth (City/State/Country): ____________________
    Home Address (Street/City/State/Zip/Country): ________________________________________

13. Information about your children (Please indicate the child who will accompany you to the U.S.)
    a.     Full Name: ________________       ___________________     ______________
                                  (Family Name)               (First Name)                       (Middle Name)
        Date of Birth (month/day/year): _____________ 
        Place of Birth (City/State/Country): ____________________
        Home Address (Street/City/State/Zip/Country): ________________________________

    b.     Full Name: ________________       ___________________     ______________
                                  (Family Name)               (First Name)                       (Middle Name)
        Date of Birth (month/day/year): _____________ 
        Place of Birth (City/State/Country): ____________________
        Home Address (Street/City/State/Zip/Country): ________________________________

    c.     Full Name: ________________       ___________________     ______________
                                  (Family Name)               (First Name)                       (Middle Name)
        Date of Birth (month/day/year): _____________ 
        Place of Birth (City/State/Country): ____________________
        Home Address (Street/City/State/Zip/Country): ________________________________

14. List all places you lived for at least six months since reaching the age of 16”

    Street        City    State    Country    From (month/year)  To (month/year)

15. List all employment for the last ten years:

    Employer Location (City/State/Country)        Job Title    From (month/year)  To (month/year)

16. List all educational institutions attended:

    School Name    Location     From (month/year)  To (month/year)  Course of study    Degree
    ___________    _______    _____________________________    __________    ______
    ___________    _______    _____________________________    __________    ______
    ___________    _______    _____________________________    __________    ______   
    ___________    _______    _____________________________    __________    ______
    ___________    _______    _____________________________    __________    ______

17. Foreign languages spoken or read: ___________________________

18. Do you belong to any professional associations? If yes, which one: ______________________

19. Have you been in military services? If yes, please indicate the following:

    Branch: ___________    Date of Service (From/To): ________________________
    Rank/Position: _____________ Military Specialty / Occupation: ______________

20. Have you ever visited the U.S.? If yes, please indicate the following:

    Visa type    From (month/year)  To (month/year)    Location (City/State)
    ________    _____________________________    _________________
    ________    _____________________________    _________________
    ________    _____________________________    _________________
    ________    _____________________________    _________________

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