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1、Personal Information 1OMB CONTROL NUMBER:1405-0185FORM NUMBER:DS-260 EXPIRATION DATE:01/31/2016 ESTIMATED BURDEN:120 MINNOTE: Data on this page must match the information as it is written in your passport or travel documents. Surnames Given NamesFull Name in Native AlphabetHave you ever used other n
2、ames (i.e., maiden, religious, professional, alias, etc.)? （yes）(no)Sex(male) female)Current Marital StatusDate of Birth(Format: DD-MMM-YYYY)City of BirthState/Province of BirthCountry/Region of BirthPersonal Information 2Country/Region of Origin (Nationality)Document TypeDocument IDCountry/Authorit
3、y that Issued DocumentIssuance Date(Format: DD-MMM-YYYY)Expiration Date(Format: DD-MMM-YYYY) Do you hold or have you held any nationality other than the one you have indicated above? (yes)(no)Present Address Street Address (Line 1)Street Address (Line 2) *Optional CityState/ProvincePostal Zone/ZIP C
4、odeCountry/RegionStarted Living Here(Format: MMM-YYYY) Previous AddressesHave you lived anywhere other than this address since the age of sixteen? (Date you turned sixteen: 23-Mar-2001)(yes) (no)Street Address (Line 1)Street Address (Line 2) *OptionalCityState/ProvincePostal Zone/ZIP CodeCountry/Reg
5、ionStarted Living Here(Format: MMM-YYYY) To Date(Format: MMM-YYYY)PhonePrimary Phone NumberSecondary Phone NumberWork Phone NumberEmailEmail AddressMailing and Permanent Address InformationIs your Mailing Address the same as your Present Address?(yes) (no)Permanent AddressPlease provide the followin
6、g information on where you intend to live after arrival in the United States. Name of person currently living at addressU.S. Street Address (Line 1)U.S. Street Address (Line 2) *Optional CityStateZIP CodePhone NumberIs this address where you want your Permanent Residence Card (Green Card) mailed? (y
7、es) (no)Family Information: ParentsFatherSurnamesGiven NamesDate of Birth(Format: DD-MMM-YYYY) Place of Birth CityState/ProvinceCountry/RegionIs your father still living?(yes) (no)Year of DeathCurrent AddressStreet Address (Line 1)Street Address (Line 2) *Optional CityState/ProvincePostal Zone/ZIP C
8、odeCountry/RegionMotherSurnames at BirthGiven NamesDate of Birth(Format: DD-MMM-YYYY) CityState/ProvinceCountry/RegionIs your mother still living?(yes) (no)Year of DeathIs your mothers address the same as your fathers?(yes) (no)Current AddressStreet Address (Line 1)Street Address (Line 2) *OptionalC
9、ityState/ProvincePostal Zone/ZIP CodeCountry/RegionFamily Information: Previous Spouse NOTE: Please provide the following information on all of your previous spouses, including those deceased. Do you have any previous spouses?(yes) (no)Family Information: ChildrenDo you have any children?(yes) (no)P
10、revious U.S. Travel InformationHave you ever been in the U.S.?(yes) (no)Have you ever been issued a U.S. Visa?*yes) (no)Have you ever been refused a U.S. Visa, been refused admission to the United States, or withdrawn your application for admission at the port of entry? (yes) (no)Present Work/Educat
11、ion/Training InformationPrimary OccupationPresent Employer or School NamePresent Employer or School address: Street Address (Line 1) Street Address (Line 2) *OptionalCityState/ProvincePostal Zone/ZIP CodeCountry/RegionDo you have other occupations?(yes) (no)n which occupation do you intend to work i
12、n the U.S.?Provide the following information:Specify OtherPrevious Work/Education/Training Information Were you previously employed?(yes) (no)Have you attended any educational institutions at a secondary level or above? (yes) (no)Additional Work/Education/Training InformationHave you ever served in
13、the military?(yes) (no)Have you belonged to, contributed to, or worked for any professional, social, or charitable organization?(yes) (no)Do you have any specialized skills or training, such as firearms, explosives, nuclear, biological, or chemical experience?(yes) (no)Explain Skills or TrainingHave
14、 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)ExplainCan you speak and/or read languages other than your native language?(yes) (no)List the languages that you speak and/or read:Petitioner InformationPetitioner is myPetitioner Petitioner SurnamesPetitioner Given NamesAddress and Phone Number of PetitionerStreet Address (Line 1)Street Address (Line 2) *OptionalCityState/ProvincePostal Zone/ZIP CodeCountry/Region
