Application

Application

Fields marked with * are required

Family name *

Given name *

Full middle name

Date of birth (month/day/year) *

Country of citizenship *

Date of last arrival into the U.S. (month/day/year)

Current nonimmigrant status (visa) *

Date status expires (month/day/year) *

Requested dates (begin and end) of extension of stay (month/day/year) *

Have you been employed in the U.S.

Yes

No

Do you have U.S. Social Security

Yes

No

Education

High school

Training

College

University

Received Major and Specialization

The status I am requesting is *

B2 visitor visa

H-2B work visa

Other

E-mail *

Phone number(s)

Additional notes