U.

S Questionnaire
Please answer all question truthfully
1. First name

2. Middle name

3. Last name

4. Gender (male/female)

5. Marital status

6. Date of birth

7. Place of birth

8. Country of nationality

9. Home Address

10. Phone number

11. Email Address

12. Please provide all social media identifier

(Please specify if this is Facebook, Instagram,
TikTok, YouTube etc)

13. Passport number

14. Date of issued Passport

15. Date of expiration of passport

16. Have you ever lost a passport?
Travel Information
17. Arrival city

18. Address where you will stay in the U.S?

(City, state, Postal/zip code)
19. Who is paying for your trip? (If other
from yourself, please provide their name)
20. Relation of the person paying for the trip
And their telephone number
21. Is the address of the person paying for
your trip the same as your home address?
(If no, please provide their address)
 22. Are there other persons travelling with
you?

23. Relation of the person travelling with

you?

24. Have you ever been refused a visa? (If

yes, please provide what country and
what was the reason you were denied)

25. What month and year did this

immigration problem occurred?

26A. Has anyone ever filed an immigration

petition on your behalf with the United States
citizenship and immigration services?

26B. Explain (26A)

U.S. Contact Information

27. Contact person name in the U.S

28. Relationship to you

29. U.S Contact Address

30. Phone number

Family Information

31. Father’s Surname

32. Father’s given names

33. Father’s date of birth

34. Is your father in the U.S.?

35. Status

36. Mother’s Surnames

37. Mother’s given names

38. Is your mother in the U.S.?

39A. Do you have any immediate relatives, not

including parents in the U.S.?
39B. Please provide the name(s) and relation for
question above.

Work/Education/Training Information
40. Primary Occupation (Student, Entrepreneur,
etc)

41. Address and telephone number of Primary

occupation

42. When did you start?