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1. Name – last/family name, first name, middle name – exactly as on your passport.
2. Birth date – day, month, year.
3. Gender – male or female.
4. City where you were born.
5. Country where you were born – Use the name of the country currently used for the place where you were born.
6. Country of eligibility for the DV Program – Your country of eligibility will normally be the same as your country of birth.
7. Entrant photograph(s)
8. Mailing Address – In Care Of Address Line 1 Address Line 2 City/Town District/Country/Province/State Postal Code/Zip Code Country
9. Country where you live today.
10. Phone number (optional).
11. E-mail address – An e-mail address to which you have direct access. If your entry is selected and you respond to the notification of your selection through the Entrant Status Check, you will receive follow-up e-mail communication from the Department of State notifying you that details of your immigrant visa interview are available on Entrant Status Check. The Department of State will never send you an e-mail telling you that you have been selected for the DV program.
12. Highest level of education you have achieved, as of today: (1) Primary school only, (2) Some high school, no diploma, (3) High school diploma, (4) Vocational school, (5) Some university courses, (6) University degree, (7) Some graduate-level courses, (8) Master’s degree, (9) Some doctoral level courses, and (10) Doctorate.
13. Current marital status – Unmarried, married, divorced, widowed, or legally separated. Enter the name, date of birth, gender, city/town of birth, country of birth of your spouse, and a photograph of your spouse meeting the same technical specifications as your photo. Failure to list your eligible spouse will result in disqualification of the principal applicant and refusal of all visas in the case at the time of the visa interview.
14. Number of children – List the Name, date of birth, gender, city/town of birth, and country of birth for all living unmarried children under 21 years of age, regardless of whether or not they are living with you or intend to accompany or follow to join you should you immigrate to the United States. Submit individual photographs of each of your children using the same technical specifications as your own photograph.
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