Apply - Official ESTA Application | Apply for Visa to USA

Applicant / Passport information

Family Name *

First(Given) Name *

Gender *

Are you known by any other names or aliases? * NO YES

Other family Name *

Other First(Given) Name *

Date of Birth *

City of Birth *

Country *

Passport Number*

Country of Citizenship*

Passport Issuing Country*

Passport Issuance Date *

Passport Expiration Date *

Have you ever been issued a passport or national identity card for travel by any other country? * NO YES

Issuing Country*

Document Type *

Document Number *

Expiration Year*

Other Citizenship/Nationality

Are you a citizen of any other country? * NO YES

Country*

How did you acquire citizenship / nationality from this country? *

Have you ever been a citizen or national of any other country? * NO YES

Country*

GE Membership

Are you a member of the CBP Global Entry Program? * NO YES

PASSID / Membership Number*

Parents Information

Family Name (Father)*

First (Given) Name (Father)*

Family Name (Mother)*

First (Given) Name (Mother)*

Contact Information

Telephone Number*

E-mail Address*

Address Line 1*

Address Line 2

Apartment Number

City*

State/Province/Region *

Country*

Employment Information

Do you have a current or previous employer? * NO YES

Job Title

Employer Name*

Address Line 1*

Address Line 2*

City*

State/Province/Region *

Country*

Telephone Number*

Travel Information

Is your travel to the US occurring in transit to another country? * NO YES

US Point of Contact Name*

US Point of Contact - Address Line 1*

US Point of Contact - Address Line 2

Apartment Number

US Point of Contact City *

State*

Telephone Number*

Is your address while in the US same as the US point of contact info above? * NO YES

US Point of Contact Name

US Point of Contact - Address Line 1

US Point of Contact - Address Line 2

Apartment Number

US Point of Contact City

State

Emergency Contact Information

Family Name*

First (Given) Name*

E-mail Address *

Telephone Number *

Eligibility Questions