Traveler Application

First (Given) Name*

Last (Family) Name/Surname*

Date of Birth*

Month

Day

Year

Sex*

Country of Citizenship*

Country of Residency*

Will you use a Passport or Border Crossing Card?

Choose the one that applies:

Contact Information

Email Address*

Phone Number*

Occupation*

Confirm Email Address*

U.S. Address

Do you want to use this address for the next 6 applicant(s)?

Address Line 1*

City*

Zip Code

State*

U.S. Contact Name

U.S. Contact First (Given) Name

U.S. Contact Last (Family) Name/Surname

Additional Information

Petition Number (optional)

SEVIS Number (optional)

By submitting this form and signing below, you confirm and agree to the following:

I certify that all information I have provided on this form is true, correct, and complete to the best of my knowledge. I understand that providing false, inaccurate, or incomplete information may result in delays, denial, penalties, or other consequences. I understand that it is my responsibility to carefully review all information before submission. I confirm that I have reviewed my entries and that they are accurate.

Signature*

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i94 Filing Service

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