american dreams

Prefix

First Name

Middle Name

Last/Family Name *

Gender *MaleFemale

Birth Date *

Mailing Address *

Address Line 1

City

State/Province

ZIP / Postal Code

Country Where You Were Born *

City Where You Were Born *Enter Birth City Only. Do not enter District/County/Province/State.

Country Where You Live Today *

Entrant Photograph

No file chosen

Photographs that do not comply with all specifications, including but not limited to recency of the photos (must be taken in the last six months), composition of the photos, and unacceptable backgrounds are grounds for disqualification of the entire entry. Any manipulation of photographs that alters the facial characteristics is grounds for disqualification of the entire entry. Must be 600x600 pixels

Phone Number

Email Address *

Confirm Email Address *(NOTE: This e-mail address will be used to provide you with additional information if you are selected.)

What is your current marital status? *UnmarriedMarried and my spouse is NOT a U.S.citizen or U.S. Lawful Permanent Resident (LPR)Married and my spouse IS a U.S.citizen or U.S. Lawful Permanent Resident (LPR)DivorcedWidowedLegally SeparatedLegal separation is an arrangement when a couple remain married but live apart, following a court order. If you and your spouse are legally separated, your spouse will not be able to immigrate with you through the program. You will not be penalized if you choose to enter the name of a spouse from whom you are legally separated. If you are not legally separated by a court order, you must include your spouse even if you plan to be divorced before you apply for the Visa. Failure to list your eligible spouse is grounds for disqualification. If your spouse is a U.S. citizen or Lawful Permanent Resident, do not list him/her in your entry.

Number of Children *Children include all biological children, legally adopted children, and stepchildren who are unmarried and under the age of 21 on the date you submit your entry. You must include all eligible children, even if they do not live with you or if they do not intend to apply for a Visa through the program as your derivative. Failure to list all eligible children is grounds for disqualification. If your child is a U.S. citizen or Lawful Permanent Resident, do not list him/her in your entry.

Child #1 Name

Child's Birth Date

GenderMaleFemale

City Where Child Was BornEnter Birth City Only. Do not enter District/County/Province/State.

Country Where Child Was Born

Child's Photograph

No file chosen

Child #2 Name

Child's Birth Date

GenderMaleFemale

City Where Child Was BornEnter Birth City Only. Do not enter District/County/Province/State.

Country Where Child Was Born

Child's Photograph

No file chosen

Child #3 Name

Child's Birth Date

GenderMaleFemale

City Where Child Was BornEnter Birth City Only. Do not enter District/County/Province/State.

Country Where Child Was Born

Child's Photograph

No file chosen

Child #4 Name

Child's Birth Date

GenderMaleFemale

City Where Child Was BornEnter Birth City Only. Do not enter District/County/Province/State.

Country Where Child Was Born

Child's Photograph

No file chosen

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