Questionnaire for an immigrant visa

Online submission of questionnaires is coming soon. For now the answers are not sent: to start your application, message us on Telegram or by email.

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Required fields are marked *

Full name *

Have you ever changed your last name, first name, or patronymic?

It is important to indicate any change, not only a last name change after marriage. Write your previous full name and the year when it was changed. If you have not changed it, put a dash.

Place of birth (city, village, settlement, other): *

Marital status *

Home address (actual): *

Do you have children? *

How many? *

Details: full name, date of birth, city, do they live with you? if not, please comment. *

Home address (registered address):

Contact phone (mobile): *

Other phone numbers over the last 5 years (if any):

Email: *

Other email addresses (if any):

Links to social media (for example, Instagram, LinkedIn, VK):

Provide information about your activity: *

If you selected Other, please describe in more detail:

Name of place of work (study):

Start date of work (study):

Work phone (educational institution phone):

Address of place of work (study):

Average monthly income (including premiums, bonuses, additional sources):

Briefly describe your duties:

Who will pay for your trip?:

Full name of spouse (all details are required even if you are divorced or living in a civil marriage):

Spouse's date of birth:

Spouse's place of birth, country and city:

Spouse's citizenship:

Residential address of spouse, if you are divorced or do not live together:

If you are divorced, you must indicate the date of marriage:

And also the date of divorce:

If you are a widower (widow), you must indicate the date of death of your spouse:

Father's full name: *

Mother's full name: *

Father's date of birth:

Mother's date of birth:

Father's place of birth:

Mother's place of birth:

Which languages (other than Russian) do you speak:

Have you ever lost your international passport or has it been stolen from you (details):

Have you previously received U.S. visas? If yes, indicate the visa type, number, date and place of issue of the most recent visa:

Do you have a Social Security card? (This item is optional). If yes, indicate its number:

List your last 5 visits to the United States (exact dates of entry to the United States, duration of stay, e.g., 1 day or 3 weeks, approximate is acceptable):

Have you ever been denied a U.S. visa? If yes, indicate the approximate date and presumed reason:

Do you have any relatives in the United States? If yes, full name, relationship, status in the United States:

Who are you planning to fly to the United States with (full name, relationship to you):

Planned address of residence in the United States and contact person (organization) (if applicable):

Trip start date (if known):

Trip end date (if known):

Number of days of stay:

Do you have or have you ever had citizenship/residence permit of another country? If yes, indicate the country and number of the citizenship/residence permit:

List all countries you have visited in the last 5 years: *

Have you ever had a criminal record? If yes, details: *

Indicate your two most recent places of employment in the last 5 years (excluding your current one):

(write below)

Employer name 1:

Work phone 1:

Employer address 1:

Job title 1:

Full name of supervisor 1:

Briefly describe your duties:

Job 1 start date:

Job 1 end date:

Employer name 2:

Work phone 2:

Employer address 2:

Job title 2:

Last name, first name of supervisor 2:

Briefly describe your duties:

Job 2 start date:

Job 2 end date:

Have you served in the military?

List all educational institutions, except general education school, that you graduated from or attended:

(write below)

Educational institution name 1:

Field of study 1:

Educational institution address 1:

Study start date 1:

Study end date 1:

Educational institution name 2:

Field of study 2:

Educational institution address 2:

Study start date 2:

Study end date 2:

If you did not have enough space for education information or have additions for any other reason, please enter them in this line: