US Questionnaire

The questions listed below are required to prepare the electronic application. Before submission to the Consulate, all answers will be translated, edited, and agreed with you in accordance with current requirements. Please note that if you do not know the answers to some questions, you may skip them and fill them in later.

82 questions, about 29 min. Answers are saved in this browser, so you can come back later.

1Documents and photo3 questions

1st page of international passport (photo)No files selected

Photo of the latest US visa (if any)

Passport spread with an old US visa. If you have never had a US visa, skip it.

No files selected

Portrait photo

Color photo of the face, full-face, on a light plain background, without glasses or headwear. You can take it with a phone in daylight.

No files selected

2About you7 questions

Full name *

Have you ever changed your last name, first name, or patronymic?

It is important to indicate any change, not only a last name change after marriage. Write your previous full name and the year when it was changed. If you have not changed it, put a dash.

Place of birth (city, village, settlement, other): *

City of international passport issuance

Home address (actual): *

Home address (registered address):

3Contacts5 questions

Contact phone (mobile): *

Other phone numbers over the last 5 years (if any):

Email: *

Other email addresses (if any):

Links to social media (for example, Instagram, LinkedIn, VK):

5Family11 questions

Full name of spouse (all details are required even if you are divorced or living in a civil marriage):

Spouse's date of birth:

Spouse's place of birth, country and city:

Spouse's citizenship:

If you are divorced, you must indicate the date of marriage:

And also the date of divorce:

If you are a widower (widow), you must indicate the date of death of your spouse:

Father's full name: *

Mother's full name: *

Father's date of birth:

Mother's date of birth:

6Trip to the USA6 questions

What city are you flying to? (If known)

Who are you planning to fly to the United States with (full name, relationship to you):

Planned address of residence in the United States and contact person (organization) (if applicable):

Trip start date (if known):

Trip end date (if known):

Number of days of stay:

7Visa history9 questions

Have you ever lost your international passport or has it been stolen from you (details):

Have you previously received U.S. visas? If yes, indicate the visa type, number, date and place of issue of only the most recent visa:

Do you have a Social Security card? (This item is optional). If yes, indicate its number:

List your last 5 visits to the United States (exact dates of entry to the United States, duration of stay, e.g., 1 day or 3 weeks, approximate is acceptable):

Have you ever been denied a U.S. visa? If yes, indicate the approximate date and presumed reason:

Do you have any relatives in the United States? If yes, full name, relationship, status in the United States:

Do you have or have you ever had citizenship/residence permit of another country? If yes, indicate the country and number of the citizenship/residence permit:

List all countries you have visited in the last 5 years:

Have you ever had a criminal record? If yes, details:

8Previous places of work17 questions

Indicate your two most recent places of employment in the last 5 years (excluding your current one):

(write below)

Employer name 1:

Work phone 1:

Employer address 1:

Job title 1:

Full name of supervisor 1:

Briefly describe your duties:

Job 1 start date:

Job 1 end date:

Employer name 2:

Work phone 2:

Employer address 2:

Job title 2:

Last name, first name of supervisor 2:

Briefly describe your duties:

Job 2 start date:

Job 2 end date:

9Education and military service13 questions

Which languages (other than Russian) do you speak:

Have you served in the military?

List all educational institutions, except general education school, that you graduated from or attended:

(write below)

Educational institution name 1:

Field of study 1:

Educational institution address 1:

Study start date 1:

Study end date 1:

Educational institution name 2:

Field of study 2:

Educational institution address 2:

Study start date 2:

Study end date 2:

10Additional2 questions

If you did not have enough space for education information or have additions for any other reason, please enter them in this line:

US Questionnaire

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