Personal Information 1 - ATENEA PROGRAMAS DE INTERCAMBIO
Transcription
Personal Information 1 - ATENEA PROGRAMAS DE INTERCAMBIO
Nonimmigrant Visa - Personal Information 1 Página 1 de 2 Online Nonimmigrant Visa Application (DS-160) Application ID AA001WXW4F Personal Information 1 OMB CONTROL NUMBER: 1405-0182 Recuerda que todos los datos que registres en este formulario deben estar de acuerdo a tu pasaporte. FORM NUMBER: DS-160 EXPIRATION DATE: 04/30/2014 ESTIMATED BURDEN: 75 MIN NOTE: Data on this page must match the information as it is written in your passport. Surnames llaque aranguri Apellidos completos. (e.g., FERNANDEZ GARCIA) Given Names Nombres completos. rafael david (e.g., JUAN MIGUEL) Full Name in Native Alphabet Does Not Apply/Technology Not Available Help: Surnames Enter all surnames as listed in your passport. If only one name is listed in your passport, enter that Surname. Help: Given Names If your passport does not include a given name, please enter 'FNU' in Given Names. Have you ever used other names (i.e., maiden, religious, professional, alias, etc.)? Yes No No. Help: Other Names Other names used include your maiden name, religious name, professional name, or any other names which you are known by or have been known by in the past. Do you have a telecode that represents your name? Yes No No. Help: Telecode Telecodes are 4 digit code numbers that represent characters in some non-Roman alphabet names. Sex Elige tu género. Male Female Marital Status SINGLE Date and Place of Birth Elige tu status, soltero, casado, etc. Date of Birth https://ceac.state.gov/GENNIV/General/complete/complete_personal.aspx?node=Pers... 10/10/2011 Nonimmigrant Visa - Personal Information 1 18 APR Página 2 de 2 Fecha de nacimiento de acuerdo a tu pasaporte. 1992 (Format: DD-MMM-YYYY) City of Birth trujillo Ciudad de nacimiento. State/Province of Birth la libertad Departamento de nacimiento. Does Not Apply Place of Birth País de nacimiento. PERU Help: Date of Birth If day or month is unknown, enter as shown in passport. Help: Place of Birth Select the name that is currently in use for the place where you were born. Public reporting burden for this collection of information is estimated to average 75 minutes per response, including time required for searching existing data sources, gathering the necessary documentation, providing the information and/or documents required, and reviewing the final collection. You do not have to supply this information unless this collection displays a currently valid OMB control number. If you have comments on the accuracy of this burden estimate and/or recommendations for reducing it, please send them to: A/ISS/DIR, Room 2400 SA-22, U.S. Department of State, Washington, DC 20522-2202 INA Section 222(f) provides that the records of the Department of States and of diplomatic and consular offices of the United States pertaining to the issuance and refusal of visas or permits to enter the United States shall be considered confidential and shall be used only for the formulation, amendment, administration, or enforcement of the immigration, nationality, and other laws of the United States. Certified copies of such records may be made available to a court provided the court certifies that the information contained in such records is needed in a case pending before the court. Back: Getting Started Save Next: Personal 2 Click para continuar. Guardar en la PC local. https://ceac.state.gov/GENNIV/General/complete/complete_personal.aspx?node=Pers... 10/10/2011 Nonimmigrant Visa - Personal Information 2 Página 1 de 1 Online Nonimmigrant Visa Application (DS-160) Application ID AA001WXW4F Personal Information 2 Nationality PERU Nacionalidad . Do you hold or have you held any nationality other than the one indicated above on nationality? Si tienes otra nacionalidad. Yes No National Identification Number Número de tu DNI. 43356789 Does Not Apply U.S. Social Security Number Does Not Apply U.S. Taxpayer ID Number - Si viajas por primera vez: Selecciona Does Not Apply. - Si viajaste antes como W&T: Registra tu número de Social Security Card. Seleccionar Does Not Apply. Does Not Apply Help: Identification Numbers Your National ID Number is a unique number that your government provides. The U.S. Government provides unique numbers to those who seek employment (Social Security Number) or pay taxes (Taxpayer ID). Back: Personal 1 Save Next: Address and Phone Click para continuar. Guardar. https://ceac.state.gov/GENNIV/General/complete/complete_personalcont.aspx?node=... 10/10/2011 Nonimmigrant Visa - Address and Phone Information Página 1 de 1 Online Nonimmigrant Visa Application (DS-160) Application ID AA001WXW4F Address and Phone Information Home Address Dirección actual (aunque no coincida con tu DNI), sin abreviaturas y sin traducir al inglés. Empezar por calle, jirón o avenida, luego el número y la urbanización. Street Address (Line 1) los sauces 792 urbanizacion california Street Address (Line 2) *Optional City trujillo Si no te alcanza todo en el primer renglón, continuar en este. Ciudad. State/Province la libertad Departamento. Does Not Apply Postal Zone/ZIP Code Does Not Apply Country PERU Para Lima, escribir el código postal de tu distrito. Para el resto de ciudades: Does Not Apply. País. Mailing Address Is your Mailing Address the same as your Home Address? Yes No Yes. Teléfono fijo de tu casa (código de país: 51, seguido del código de tu ciudad, seguido del número de tu teléfono fijo. Sin ceros. Phone Primary Phone Number 5144423962 Secondary Phone Number Does not apply. Does Not Apply Work Phone Number Does not apply. Does Not Apply Help: Phone You must provide a primary phone number. The primary phone number should be the phone number at which you are most likely to be reached; this could be a land line or a cellular/mobile number. If you have an additional land line or a cellular/mobile number please list that as your secondary phone number. Email Address Tu correo electrónico. Email Address [email protected] Does Not Apply (e.g., [email protected]) Back: Personal Save Next: Passport Click para continuar. Guardar. https://ceac.state.gov/GENNIV/General/complete/complete_contact.aspx?node=Addr... 10/10/2011 Nonimmigrant Visa - Passport Information Página 1 de 1 Online Nonimmigrant Visa Application (DS-160) Application ID AA001WXW4F Passport Information Help: Passport/Travel Document Number Enter the information on the travel document you will be using when traveling to the U.S. Your travel document should be a valid, unexpired passport or other valid, unexpired documentation that is sufficient to establish your identity and nationality. REGULAR Passport/Travel Document Type Passport/Travel Document Number 23456 Número de tu pasaporte. Help: Passport Book Number The Passport Book Number is commonly called the inventory control number. You may or may not have a Passport Book Number on your passport. The location of the Passport Book Number on your passport may vary depending on the country that issued your passport. Please contact your passport issuing authority if you are unable to determine whether or not your passport contains a Passport Book Number. Does Not Apply. Passport Book Number Does Not Apply Country/Authority that Issued Passport/Travel Document PERU Where was the Passport/Travel Document Issued? Ciudad de emisión de tu pasaporte. City trujillo State/Province *If shown on passport Departamento de emisión de tu pasaporte. la libertad Country PERU País de emisión de tu pasaporte. Issuance Date 15 APR 2011 Fecha de emisión de tu pasaporte. (Format: DD-MMM-YYYY) Help: Expiration Date In most cases your passport/Travel Document must have at least six months of validity beyond the date of your visa application and/or your arrival in the United States. Fecha de expiración de tu pasaporte. Expiration Date 15 APR 2015 Does Not Apply (Format: DD-MMM-YYYY) Have you ever lost a passport or had one stolen? Si perdiste un pasaporte. Yes No Back: Address and Phone Save Next: Travel Click para continuar. Guardar. https://ceac.state.gov/GENNIV/General/complete/Passport_Visa_Info.aspx?node=Ppt... 10/10/2011 Nonimmigrant Visa - Travel Information Página 1 de 2 Online Nonimmigrant Visa Application (DS-160) Application ID AA001WXW4F Travel Information NOTE: Provide the following information concerning your travel plans. Provide the following information: Purpose of Trip to the U.S. EXCHANGE VISITOR (J) Propósito de viaje. EXCHANGE VISITOR (J1) Specify Visita de intercambio. Add Another Remove Have you made specific travel plans? No. Yes No Intended Date of Arrival 12 DEC 2011 (Format: DD-MMM-YYYY) Intended Length of Stay in U.S. 3 Month(s) Help: Arrival Plans Fecha de viaje, 2 días antes del inicio de tu contrato de trabajo. Registra el tiempo que permanecerás en EE.UU., incluye sólo la duración de tu contrato de trabajo. If you are unsure of your travel plans, please provide an estimate. Address Where You Will Stay in the U.S. Street Address (Line 1) EOK PARK ST 566 Street Address (Line 2) *Optional EOK PARK Dirección de tu empleador, lo encuentras en tu Job Offer. City LUXE Ciudad. State ILLINOIS Estado. ZIP Code (if known) 12345 Código Postal. (e.g., 12345 or 12345-1234) Person/Entity Paying for Your Trip Other Person Other Person. Provide the following information: Surnames of Person Paying for Trip LLAQUE PAREDES Apellidos de tu papá. (e.g., FERNANDEZ GARCIA) Given Names of Person Paying for Trip RAFAEL (e.g., JUAN MIGUEL) Telephone Number 5144423962 Email Address Nombres de tu papá. Número de teléfono fijo de tu casa (el mismo que pusiste en Phone Information, incluyendo código de país y ciudad). https://ceac.state.gov/GENNIV/General/complete/complete_travel.aspx?node=Travel 10/10/2011 Nonimmigrant Visa - Travel Information Página 2 de 2 Correo electrónico de tu papá. [email protected] Does Not Apply (e.g., [email protected]) Relationship to You Parent. PARENT Is the address of the party paying for your trip the same as your Home or Mailing Address? Yes. Yes No Back: Passport Save Next: Travel Companions Click para continuar. Guardar. https://ceac.state.gov/GENNIV/General/complete/complete_travel.aspx?node=Travel 10/10/2011 19/10/2011 Nonimmigrant Visa - Travel Companio… Online Nonimmigrant Visa Application (DS-160) Application ID AA001WWTC9 Travel Companions Information NOTE: Provide the following travel companion information. Persons traveling with you Are there other persons traveling with you? Yes. Yes No Help: Traveling with Others You should answer Yes to this question if you are traveling with family, as part of an organized tour, or as part of a performing group or athletic team. You do not need to list individuals who are traveling with you for the purposes of employment with the same employer. Are you traveling as part of a group or organization? Yes. Yes No Enter the name of the group you are traveling with Group Name ATENEA PROGRAMAS DE INTERCAMBIO Back: Travel Save Atenea Programas de Intercambio. Next: Previous U.S. Travel Click para continuar. Guardar. …state.gov/…/complete_travelcompan… 1/1 Nonimmigrant Visa - Previous U.S. Travel Information Página 1 de 2 Online Nonimmigrant Visa Application (DS-160) Application ID AA001WXW4F Previous U.S. Travel Information NOTE: Provide the following previous U.S. travel information. Provide complete and accurate information to all questions that require an explanation. Have you ever been in the U.S.? Has viajado antes a Estados Unidos? Yes No Provide information on your last five U.S. visits: Date Arrived 15 DEC Si tu respuesta es SI: Completar la fecha de arribo a EE.UU. y el tiempo que permaneciste. Si has estado más de una vez en EE.UU., registrar todas, desde la más reciente hacia la más antigua. 2010 (Format: DD-MMM-YYYY) Length of Stay 3 Month(s) Add Another Remove Do you or did you ever hold a U.S. Driver’s License? Tramitaste licencia de conducir en EE.UU.? Yes No Help: Previous U.S. Visits If you are unsure about when you visited the U.S., please provide a best estimate. Have you ever been issued a U.S. Visa? Te han emitido visa para EE.UU. antes? Yes No Previous U.S. Visas Date Last Visa Was Issued 12 OCT 2010 (Format: DD-MMM-YYYY) Si tu respuesta es SI, completar la fecha de emisión y el número de tu última visa. Visa Number 234567 Do Not Know Are you applying for the same type of visa? Yes No Estas aplicando para el mismo tipo de visa? Are you applying in the same country where the visa above was issued and is this country your principal country of residence? Estas aplicando en el mismo país? https://ceac.state.gov/GENNIV/General/complete/complete_previousustravel.aspx?no... 10/10/2011 Nonimmigrant Visa - Previous U.S. Travel Information Página 2 de 2 Yes No Tomaron tus 10 huellas digitales, cuando tramitaste la visa anterior? Have you been ten-printed? Yes No Has your U.S. Visa ever been lost or stolen? Has perdido o te han robado un pasaporte visado (con visa para EE.UU.)? Yes No Has your U.S. Visa ever been cancelled or revoked? Yes No Te han cancelado una visa para EE.UU.? (Se refiere a si la tuviste y te la quitaron por algún motivo. Help: Visa Number Enter the 8-digit number that is displayed in red on the lower right hand side of your visa. If your previous visa was a Border Crossing Help: Ten-printed Card enter the last 12-digit number of the first line of the machine readable zone. Ten-printed means that you have provided fingerprints for all your fingers, as opposed to having provided only two fingerprints. Have you ever been refused a U.S. Visa, been refused admission to the United States, or withdrawn your application for admission at the port of entry? Te han negado una visa o la entrada a EE.UU.? Yes No Explain Indicar el tipo de visa y el año? Tourism visa, 2005. Has anyone ever filed an immigrant petition on your behalf with the United States Citizenship and Immigration Services? Alguien ha gestionado una petición a tu nombre en el servicio de inmigrantes? Yes No Explain Si la respuesta es SI, detallar el año. yes, 2009. Back: Travel Companions Save Next: U.S. Contact Click para continuar. Guardar. https://ceac.state.gov/GENNIV/General/complete/complete_previousustravel.aspx?no... 10/10/2011 Nonimmigrant Visa - U.S. Point of Contact Information Página 1 de 1 Online Nonimmigrant Visa Application (DS-160) Application ID AA001WXW4F U.S. Point of Contact Information Datos de tu sponsor, los tienes en tu DS 2019, en el punto 7. Contact Person or Organization in the United States Contact Person Surnames maloney Apellidos de la persona que firma el DS 2019. Given Names courtney Nombres de la persona que firma el DS 2019. Do Not Know Organization Name spirit cultural exchange Nombre de tu sponsor, lo tienes en el Punto 2 del DS 2019. Relationship to You OTHER Do Not Know Other. Help: Contact Your U.S. Point of Contact can be any individual in the U.S. who knows you and can verify, if necessary, your identity. If you do not personally know anyone in the U.S., you may enter the name of the store, company, or organization you plan to visit during your trip. Address and Phone Number of Point of Contact U.S. Street Address (Line 1) 137 north oak park avenue suite 304 Dirección de tu sponsor. U.S. Street Address (Line 2) *Optional City oak park State ILLINOIS 60301 ZIP Code (if known) (e.g., 55555 or 55555-5555) Phone Number (708)763-8940 Número de teléfono de tu sponsor. (e.g., (555)555-5555) Email Address Email del Manager del sponsor. [email protected] Does Not Apply (e.g., [email protected]) Back: Previous U.S. Travel Save Next: Family Click para continuar. Guardar. https://ceac.state.gov/GENNIV/General/complete/complete_uscontact.aspx?node=US... 10/10/2011 Nonimmigrant Visa - Family Information: Relatives Página 1 de 1 Online Nonimmigrant Visa Application (DS-160) Application ID AA001WXW4F Family Information: Relatives NOTE: Please provide the following information concerning your biological parents. If you are adopted, please provide the following information on your adoptive parents. Father's Full Name and Date of Birth Apellidos completos de tu papá. Surnames llaque paredes (e.g., Hernandez Garcia) Nombres completos de tu papá. Given Names rafael rodolfo Do Not Know (e.g., Juan Miguel) Do Not Know Date of Birth 28 MAR Fecha de nacimiento de tu papá. 1960 (Format: DD-MMM-YYYY) Do Not Know Is your father in the U.S.? Se encuentra tu padre en Estados Unidos? Si la respuesta es SI, registrar su status. Yes No Mother's Full Name and Date of Birth Surnames aranguri lopez Apellidos completos de tu mamá. (e.g., Hernandez Garcia) Do Not Know Nombres completos de tu mamá. Given Names teresa jimena (e.g., Juanita Miguel) Do Not Know Date of Birth 03 APR Fecha de nacimiento de tu mamá. 1965 (Format: DD-MMM-YYYY) Do Not Know Is your mother in the U.S.? Yes No Se encuentra tu madre en Estados Unidos? Si la respuesta es SI, registrar su status. Do you have any immediate relatives, not including parents, in the United States? Tienes familiares en Estados Unidos, responder si, sólo si son tus hermanos de padre y madre. Yes No Help: Immediate Relatives Means fiancé/fiancée, spouse (husband/wife), child (son/daughter), or sibling (brother/sister). Back: U.S. Contact Save Next: Work/Education/Training Click para continuar. Guardar. https://ceac.state.gov/GENNIV/General/complete/complete_family1.aspx?node=Relat... 10/10/2011 Nonimmigrant Visa - Present Work/Education/Training Information Página 1 de 1 Online Nonimmigrant Visa Application (DS-160) Application ID AA001WXW4F Present Work/Education/Training Information NOTE: Provide the following information concerning your current employment or education. Primary Occupation Student STUDENT Present Employer or School Name universidad privada del norte Nombre completo de tu universidad. Present employer or school address: Street Address (Line 1) avenida de el ejercito 920 Dirección completa de tu universidad, sin traducción al inglés, sin abreviaturas, sin símbolos (Nº, #). Si no te alcanza en el primer renglón continua en el segundo. Street Address (Line 2) *Optional urbanizacion el molino Ciudad. City trujillo Departamento. State/Province la libertad Does Not Apply Postal Zone/ZIP Code Para Lima: Usar el código postal del distrito en el que se ubica la universidad. Para otras ciudades: Does Not Apply. Does Not Apply Phone Number 5144220062 Número de teléfono de tu universidad. Country PERU Monthly Income in Local Currency (if employed) PERU. Does Not Apply Briefly describe your duties: regular student Does Not Apply. Regular Student. Back: Family Save Next: Work/Education: Previous Click para continuar. Guardar. https://ceac.state.gov/GENNIV/General/complete/complete_workeducation1.aspx?no... 10/10/2011 Responder SI, sólo si has viajado como Work and Travel en temporadas anteriores. Nombre de tu empleador. Dirección de tu empleador. Ciudad. Estado. Código postal. País. Número de teléfono. Puesto que desempeñaste. Apellidos de tu supervisor. Nombres de tu supervisor. Fecha de inicio de tu Job Offer. Fecha de término de tu Job Offer. Describe tus funciones. SI. Registrar los datos de tu colegio (Nivel Secundario). Nombre de tu colegio. Dirección de tu colegio. Ciudad. Departamento. Para Lima: Código postal del distrito al que pertenece. Para otras ciudades: Does Not Apply. País. Academic. Fecha de inicio de tu primer año en secundaria. Fecha de término de tu quinto año en secundaria. Guardar. Click para continuar. Nonimmigrant Visa - Additional Work/Education/Training Information Página 1 de 1 Online Nonimmigrant Visa Application (DS-160) Application ID AA001WXW4F Additional Work/Education/Training Information NOTE: Provide the following work, education, or training related information. Provide complete and accurate information to all questions that require an explanation. Do you belong to a clan or tribe? Yes No No. Provide a List of Languages You Speak Language Name spanish Add Another Remove Registrar los idiomas que hablas: Empezando por el español, luego inglés y los demás. Para agregar los demás idiomas hacer click en Add Another. Language Name english Add Another Remove Have you traveled to any countries within the last five years? Yes No Provide a List of Countries Visited Responder de acuerdo a tu perfil, si la respuesta es si, registrar el nombre del o los países que visitaste. Countries BRAZIL Add Another Remove Have you belonged to, contributed to, or worked for any professional, social, or charitable organization? Yes No No. Do you have any specialized skills or training, such as firearms, explosives, nuclear, biological, or chemical experience? Yes No No. Have you ever served in the military? Yes No No. Have you ever served in, been a member of, or been involved with a paramilitary unit, vigilante unit, rebel group, guerrilla group, or insurgent organization? Yes No No. Back: Work/Education: Previous Save Next: Security and Background Click para continuar. Guardar. https://ceac.state.gov/GENNIV/General/complete/complete_workeducation3.aspx?no... 10/10/2011 Nonimmigrant Visa - Security and Background: Part 1 Página 1 de 1 Online Nonimmigrant Visa Application (DS-160) Application ID AA001WXW4F Security and Background: Part 1 NOTE: Provide the following security and background information. Provide complete and accurate information to all questions that require an explanation. A visa may not be issued to persons who are within specific categories defined by law as inadmissible to the United States (except when a waiver is obtained in advance). Are any of the following applicable to you? While a YES answer does not automatically signify ineligibility for a visa, if you answer YES you may be required to personally appear before a consular officer. Do you have a communicable disease of public health significance? (Communicable diseases of public significance include chancroid, gonorrhea, granuloma inguinale, infectious leprosy, lymphogranuloma venereum, infectious stage syphilis, active tuberculosis, and others diseases as determined by the Department of Health and Human Services.) Yes No No. Do you have a mental or physical disorder that poses or is likely to pose a threat to the safety or welfare of yourself or others? Yes No No. Are you or have you ever been a drug abuser or addict? Yes No No. Back: Work/Education/Training Save Next: Security/Background Part 2 Click para continuar. Guardar. https://ceac.state.gov/GENNIV/General/complete/complete_securityandbackground1.... 10/10/2011 Nonimmigrant Visa - Security and Background: Part 2 Página 1 de 1 Online Nonimmigrant Visa Application (DS-160) Application ID AA001WXW4F Security and Background: Part 2 NOTE: Provide the following security and background information. Provide complete and accurate answers to all questions that require an explanation. A visa may not be issued to persons who are within specific categories defined by law as inadmissible to the United States (except when a waiver is obtained in advance). Are any of the following applicable to you? While a YES answer does not automatically signify ineligibility for a visa, if you answer YES you may be required to personally appear before a consular officer. Have you ever been arrested or convicted for any offense or crime, even though subject of a pardon, amnesty, or other similar action? No. Yes No Have you ever violated, or engaged in a conspiracy to violate, any law relating to controlled substances? Yes No No. Are you coming to the United States to engage in prostitution or unlawful commercialized vice or have you been engaged in prostitution or procuring prostitutes within the past 10 years? Yes No No. Have you ever been involved in, or do you seek to engage in, money laundering? Yes No No. Have you ever committed or conspired to commit a human trafficking offense in the United States or outside the United States? Yes No No. Have you ever knowingly aided, abetted, assisted or colluded with an individual who has committed, or conspired to commit a severe human trafficking offense in the United States or outside the United States? Yes No No. Are you the spouse, son, or daughter of an individual who has committed or conspired to commit a human trafficking offense in the United States or outside the United States and have you within the last five years, knowingly benefited from the trafficking activities? Yes No No. Back: Security/Background Part 1 Save Next: Security/Background Part 3 Click para continuar. Guardar. https://ceac.state.gov/GENNIV/General/complete/complete_securityandbackground2.... 10/10/2011 Nonimmigrant Visa - Security and Background: Part 3 Página 1 de 1 Online Nonimmigrant Visa Application (DS-160) Application ID AA001WXW4F Security and Background: Part 3 NOTE: Provide the following security and background information. Provide complete and accurate information to all questions that require an explanation. A visa may not be issued to persons who are within specific categories defined by law as inadmissible to the United States (except when a waiver is obtained in advance). Are any of the following applicable to you? While a YES answer does not automatically signify ineligibility for a visa, if you answer YES you may be required to personally appear before a consular officer. Do you seek to engage in espionage, sabotage, export control violations, or any other illegal activity while in the United States? Yes No No. Do you seek to engage in terrorist activities while in the United States or have you ever engaged in terrorist activities? No. Yes No Have you ever or do you intend to provide financial assistance or other support to terrorists or terrorist organizations? Yes No No. Are you a member or representative of a terrorist organization? Yes No No. Have you ever ordered, incited, committed, assisted, or otherwise participated in genocide? Yes No No. Have you ever committed, ordered, incited, assisted, or otherwise participated in torture? Yes No No. Have you committed, ordered, incited, assisted, or otherwise participated in extrajudicial killings, political killings, or other acts of violence? Yes No No. Have you ever engaged in the recruitment or the use of child soldiers? Yes No No. Have you, while serving as a government official, been responsible for or directly carried out, at any time, particularly severe violations of religious freedom? Yes No No. Have you ever been directly involved in the establishment or enforcement of population controls forcing a woman to undergo an abortion against her free choice or a man or a woman to undergo sterilization against his or her free will? Yes No No. Have you ever been directly involved in the coercive transplantation of human organs or bodily tissue? Yes No No. Back: Security/Background Part 2 Save Next: Security/Background Part 4 Click para continuar. Guardar. https://ceac.state.gov/GENNIV/General/complete/complete_securityandbackground3.... 10/10/2011 Nonimmigrant Visa - Security and Background: Part 4 Página 1 de 1 Online Nonimmigrant Visa Application (DS-160) Application ID AA001WXW4F Security and Background: Part 4 NOTE: Provide the following security and background information. Provide complete and accurate information to all questions that require an explanation. A visa may not be issued to persons who are within specific categories defined by law as inadmissible to the United States (except when a waiver is obtained in advance). Are any of the following applicable to you? While a YES answer does not automatically signify ineligibility for a visa, if you answer YES you may be required to personally appear before a consular officer. Have you ever been the subject of a removal or deportation hearing? Yes No No. Have you ever sought to obtain or assist others to obtain a visa, entry into the United States, or any other United States immigration benefit by fraud or willful misrepresentation or other unlawful means? Yes No No. Have you failed to attend a hearing on removability or inadmissibility within the last five years? Yes No No. Have you ever been unlawfully present, overstayed the amount of time granted by an immigration official or otherwise violated the terms of a U.S. visa? Yes No No. Back: Security/Background Part 3 Save Next: Security/Background Part 5 Click para continuar. Guardar. https://ceac.state.gov/GENNIV/General/complete/complete_securityandbackground4.... 10/10/2011 Nonimmigrant Visa - Security and Background: Part 5 Página 1 de 1 Online Nonimmigrant Visa Application (DS-160) Application ID AA001WXW4F Security and Background: Part 5 NOTE: Provide the following security and background information. Provide complete and accurate information to all questions that require an explanation. A visa may not be issued to persons who are within specific categories defined by law as inadmissible to the United States (except when a waiver is obtained in advance). Are any of the following applicable to you? While a YES answer does not automatically signify ineligibility for a visa, if you answer YES you may be required to personally appear before a consular officer. Have you ever withheld custody of a U.S. citizen child outside the United States from a person granted legal custody by a U.S. court? No. Yes No Have you voted in the United States in violation of any law or regulation? Yes No No. Have you ever renounced United States citizenship for the purposes of avoiding taxation? Yes No No. Have you attended a public elementary school on student (F) status or a public secondary school after November 30, 1996 without reimbursing the school? Yes No No. Back: Security/Background Part 4 Save Next: Student/Exchange Visa Click para continuar. Guardar. https://ceac.state.gov/GENNIV/General/complete/complete_securityandbackground5.... 10/10/2011 Nonimmigrant Visa - Additional Point of Contact Information Página 1 de 2 Online Nonimmigrant Visa Application (DS-160) Application ID AA001WXW4F Additional Point of Contact Information NOTE: You have indicated that you will be studying in some capacity while in the United States. List at least two contacts in your country of residence who can verify the information that you have provided on this application. Do not list immediate family members or other relatives. Postal office box numbers are unacceptable. Surnames reyes garcia Given Names fabiola sofia Street Address (Line 1) avenida larco 234 urbanizacion el recreo Apellidos del primer contacto. Nombres del primer contacto. Street Address (Line 2) *Optional City trujillo Dirección completa del primer contacto. Registrar 2 personas de contacto, no familiares, mayores de 18 años, que vivan en tu misma ciudad, no necesariamente deben hablar inglés, pero deben conocer la información que estas llenando en este formulario para dar referencia de tu persona. State/Province la libertad Does Not Apply Postal Zone/ZIP Code Does Not Apply Country PERU Telephone Number 5144342567 Does Not Apply Número de teléfono fijo del primer contacto. Email Address [email protected] Does Not Apply (e.g., [email protected]) Add Another Remove Email del primer contacto. Surnames gamero cordova Given Names edith paola Street Address (Line 1) avenida husares de junin 238 Street Address (Line 2) *Optional urbanizacion el recreo Apellidos del segundo contacto. Nombres del segundo contacto. City trujillo State/Province la libertad Does Not Apply Dirección completa del segundo contacto. Postal Zone/ZIP Code Does Not Apply Country PERU Telephone Number 5144678976 Does Not Apply Email Address Número de teléfono fijo del segundo contacto. https://ceac.state.gov/GENNIV/General/complete/complete_ExchangeVisitorAddCon... 10/10/2011 Nonimmigrant Visa - Additional Point of Contact Information [email protected] Email del segundo contacto. Does Not Apply (e.g., [email protected]) Add Another Remove Back: Security and Background Página 2 de 2 Save Next: SEVIS Click para continuar. Guardar. https://ceac.state.gov/GENNIV/General/complete/complete_ExchangeVisitorAddCon... 10/10/2011 Nonimmigrant Visa - SEVIS Information Página 1 de 1 Online Nonimmigrant Visa Application (DS-160) Application ID AA001WXW4F SEVIS Information NOTE: You have indicated that the purpose of your trip to the U.S. is to be a student or exchange visitor. Provide the following information regarding the institution at which you intend to study. SEVIS ID n2344555666 Número de sevis, lo tienes en la parte superior de tu DS 2019, junto al código de barras. (e.g., N0123456789) Program Number p-3-06087 Do you intend to study in the U.S.? Yes No Back: Additional Contact Exchange Visitor Program Number: Código que tienes en el punto 2 de tu DS 2019. No. Save Next: PHOTO Click para continuar. Guardar. https://ceac.state.gov/GENNIV/General/complete/complete_ExchangeVisitorStudent... 10/10/2011 Nonimmigrant Visa - Upload Photo Página 1 de 1 Online Nonimmigrant Visa Application (DS-160) Application ID AA001WXW4F Upload Photo Click on the Upload Your Photo button below to access our photo submission system. Once there you will be given instructions on how to supply an approved photo for your Visa application. After you have selected the photo to upload and the system verifies the photo is acceptable, you will return to “Confirm Photo” to continue the application process. Enviar consulta Back: COMPLETE Save Save Adjuntar el archivo de la foto visa (el mismo que probaste anteriormente). Next: Next: Confirm Confirm Photo Photo https://ceac.state.gov/GENNIV/General/photo/photo_uploadthephoto.aspx?node=Upl... 10/10/2011 Upload Photo // U.S. Department of State Página 1 de 1 Upload Photo Photo Quality Standards In order to ensure the highest quality photos will be used in the final printed travel document, the Department of State has created a guide for you to use when creating and uploading your photos [see photo quality standards guide]. Select Your Photo Click the "Browse" button and choose a JPEG format image (i.e., .jpg file type) that is 240 KB or less in file size. Selected Photo: Una vez adjuntada la foto, click para continuar, te solicitará que revises la aplicación, verifica que todos los datos ingresados estén correctos, debes hacerlo rapidamente para evitar que la aplicación caduque. Photo: Examinar... This site is managed by the Bureau of Consular Affairs, U.S. Department of State. External links to other Internet sites should not be construed as an endorsement of the views contained therein. Copyright Information Disclaimers Paperwork Reduction Act https://identix.state.gov/qotw/Upload.aspx?eKv7toMa91SCRQS4%2b8d77CbzbZXfk... 10/10/2011 Nonimmigrant Visa - Sign and Submit Página 1 de 1 Online Nonimmigrant Visa Application (DS-160) Application ID AA001WXW4F Sign and Submit Read the following information carefully before dating, electronically signing and submitting the application. Your application is now ready to be submitted. Please note that this does not necessarily mean that your application for a nonimmigrant visa is complete, as additional information may be needed after Department of State personnel have reviewed the application. By clicking “Sign and Submit Application” you are electronically signing the application. You are required to electronically sign your application yourself, unless otherwise exempt by regulation, even if the application has been prepared by someone other than yourself. Your electronic signature certifies that you have read and understood the questions in this application and that your answers are true and correct to the best of your knowledge and belief. The submission of an application containing any false or misleading statements may result in the permanent refusal of a visa or the denial of entry into the United States. All declarations made in this application are unsworn declarations made under penalty of perjury. (28 U.S.C. 1746). The information that you have provided in your application and other information submitted with your application may be accessible to other government agencies having statutory or other lawful authority to use such information, including for law enforcement and immigration law enforcement purposes. The photograph that you provide with your application may be used for employment verification or other U.S. law purposes. Human Trafficking Prevention Pursuant to Section 202 of the William Wilberforce Trafficking Victims Protection Reauthorization Act of 2008 you are required to receive a copy of an informational pamphlet on the legal rights and resources of aliens applying for employment- or education-based nonimmigrants visas. Please read the pamphlet carefully. We strongly encourage you to print a copy of a pamphlet and keep it with you if your visa is granted and you travel to the United States. William Wilberforce Trafficking Victims Protection Reauthorization Act of 2008 Pamphlet I certify that I have viewed and read the William Wilberforce Trafficking Victims Protection Reauthorization Act of 2008 Pamphlet. Monday, October 10, 2011 - 7:59:02 PM EST Dar Click para activar el check. Preparer of Application Did anyone assist you in filling out this application? No. Yes No Número de tu pasaporte. E-Signature I certify under penalty of perjury under the laws of the United States of America that the foregoing is true and correct. Enter your Passport/Travel Document Number: 24354 Registrar el código que aparece en el recuadro negro. Enter the code as shown: pn5rf Antes de dar click en Submit, guardar online Click the button below to electronically sign your application: la aplicación. Sign and Submit Application Back: REVIEW Save Next: Confirmation Dar click para enviar a la base de datos de la embajada. A partir de ese momento ya no se puede realizar ningún cambio. Click para confirmar e imprimir la hoja de confirmación, a colores y en impresora con muy buena tinta. Guardar el archivo en tu PC local. Esa hoja deberás llevarla el día de tu entrevista. https://ceac.state.gov/GENNIV/General/esign/signtheapplication.aspx?node=SignCert... 10/10/2011