美国移民DS260表全文(English)

Personal Information 1 OMB CONTROL NUMBER: 1405-0185 FORM NUMBER: DS-260 EXPIRATION DATE: 01/31/2016 ESTIMATED BURDEN: 120 MIN

NOTE: Data on this page must match the information as it is written in your passport or travel documents.

Surnames

Given Names

Full Name in Native Alphabet

Have you ever used other names (i.e., maiden, religious, professional, alias, etc.)?

（yes）(no)

Sex

(male) female)

Current Marital Status

Date of Birth

(Format: DD-MMM-YYYY)

City of Birth

State/Province of Birth

Country/Region of Birth

Personal Information 2

Country/Region of Origin (Nationality)

Document Type

Document ID

Country/Authority that Issued Document

Issuance Date

(Format: DD-MMM-YYYY)

Expiration Date

(Format: DD-MMM-YYYY)

Do you hold or have you held any nationality other than the one you have indicated above?

(yes)(no)

Present Address

Street Address (Line 1)

Street Address (Line 2) *Optional

City

State/Province

Postal Zone/ZIP Code

Country/Region

Started Living Here

(Format: MMM-YYYY)

Previous Addresses

Have you lived anywhere other than this address since the age of sixteen? (Date you turned sixteen: 23-Mar-2001)

(yes) (no)

Street Address (Line 1)

Street Address (Line 2) *Optional

City

State/Province

Postal Zone/ZIP Code

Country/Region

Started Living Here

(Format: MMM-YYYY)

To Date

(Format: MMM-YYYY)

Phone

Primary Phone Number

Secondary Phone Number

Work Phone Number

Email

Email Address

Mailing and Permanent Address Information

Is your Mailing Address the same as your Present Address?

(yes) (no)

Permanent Address

Please provide the following information on where you intend to live after arrival in the United States.

Name of person currently living at address

U.S. Street Address (Line 1)

U.S. Street Address (Line 2) *Optional

City

State

ZIP Code

Phone Number

Is this address where you want your Permanent Residence Card (Green Card) mailed?

(yes) (no)

Family Information: Parents

Father

Surnames

Given Names

Date of Birth

(Format: DD-MMM-YYYY)

Place of Birth

City

State/Province

Country/Region

Is your father still living? (yes) (no)

Current Address

Street Address (Line 1)

Street Address (Line 2) *Optional City

State/Province

Postal Zone/ZIP Code

Country/Region

Mother

Surnames at Birth

Given Names

Date of Birth

(Format: DD-MMM-YYYY)

City

State/Province

Country/Region

Is your mother still living?

(yes) (no)

Is your mother's address the same as your father's?

(yes) (no)

Current Address

Street Address (Line 1)

Street Address (Line 2) *Optional

City

State/Province

Postal Zone/ZIP Code

Country/Region

Family Information: Previous Spouse

NOTE: Please provide the following information on all of your previous spouses, including those deceased.

Do you have any previous spouses?

(yes) (no)

Family Information: Children

Do you have any children?

(yes) (no)

Previous U.S. Travel Information

Have you ever been in the U.S.?

(yes) (no)

Have you ever been issued a U.S. Visa?

*yes) (no)

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?

(yes) (no)

Present Work/Education/Training Information

Primary Occupation

Present Employer or School Name

Present Employer or School address:

Street Address (Line 1)

Street Address (Line 2) *Optional

City

State/Province

Postal Zone/ZIP Code

Country/Region

Do you have other occupations?

(yes) (no)

n which occupation do you intend to work in the U.S.?

Previous Work/Education/Training Information

Were you previously employed?

(yes) (no)

Have you attended any educational institutions at a secondary level or above?

(yes) (no)

Additional Work/Education/Training Information Have you ever served in the military?

(yes) (no)

Have you belonged to, contributed to, or worked for any professional, social, or charitable organization?

(yes) (no)

Do you have any specialized skills or training, such as firearms, explosives, nuclear, biological, or chemical experience?

(yes) (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)

Can you speak and/or read languages other than your native language?

(yes) (no)

List the languages that you speak and/or read:

Petitioner Information

Petitioner is my

Petitioner

Petitioner Surnames

Petitioner Given Names

Address and Phone Number of Petitioner

Street Address (Line 1)

Street Address (Line 2) *Optional

City

State/Province

Postal Zone/ZIP Code

Country/Region

Telephone

Mobile/Cell Telephone

Email Address

Security and Background: Medical and Health Information

Do you have a communicable disease of public health significance such as tuberculosis (TB)?

(yes) (no)

Do you have documentation to establish that you have received vaccinations in accordance with U.S. law?

(yes) (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)

Are you or have you ever been a drug abuser or addict?

(yes) (no)

Security and Background: Criminal Information Have you ever been arrested or convicted for any offense or crime, even though subject of a pardon, amnesty, or other similar action? (yes) (no)

Have you ever violated, or engaged in a conspiracy to violate, any law relating to controlled substances?

(yes) (no)

Are you the spouse, son, or daughter of an individual who has violated any controlled substance trafficking law, and have knowingly benefited from the trafficking activities in the past five years? (yes) (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)

Have you ever been involved in, or do you seek to engage in, money laundering?

(yes) (no)

Have you ever committed or conspired to commit a human trafficking offense in the United States or outside the United States?

(yes) (no)

Have you ever knowingly aided, abetted, assisted, or colluded with an individual who has been identified by the President of the United States as a person who plays a significant role in a severe form of trafficking in persons?

(yes) (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)

Security and Background: Security Information 1

Do you seek to engage in espionage, sabotage, export control violations, or any other illegal activity while in the United States? (yes) (no)

Do you seek to engage in terrorist activities while in the United States or have you ever engaged in terrorist activities?

(yes) (no)

Have you ever or do you intend to provide financial assistance or other support to terrorists or terrorist organizations?

(Yes) (no)

Are you a member or representative of a terrorist organization? (yes) (no)

Have you ever ordered, incited, committed, assisted, or otherwise participated in genocide?

(yes) (no)

Have you ever committed, ordered, incited, assisted, or otherwise participated in torture?

(yes) (no)

Have you committed, ordered, incited, assisted, or otherwise participated in extrajudicial killings, political killings, or other acts of violence?

(yes) (no)

Have you ever engaged in the recruitment of or the use of child soldiers?

(yes) (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)

Security and Background: Security Information 2

Are you a member of or affiliated with the Communist or other totalitarian party?

(yes) (no)

Have you ever directly or indirectly assisted or supported any of the groups in Colombia known as the Revolutionary Armed Forces of Colombia (FARC), National Liberation Army (ELN), or United Self-Defense Forces of Colombia (AUC)?

(yes) (no)

Have you ever, through abuse of governmental or political position converted for personal gain, confiscated or expropriated property in a foreign nation to which a United States national had claim of ownership?

(yes) (no)

Are you the spouse, minor child, or agent of an individual who has through abuse of governmental or political position converted for personal gain, confiscated or expropriated property in a foreign nation to which a United States national had claim of ownership? (yes) (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 choice?

(yes) (no)

Have you ever disclosed or trafficked in confidential U.S. business information obtained in connection with U.S. participation in the Chemical Weapons Convention?

(yes) (no)

Are you the spouse, minor child, or agent of an individual who has disclosed or trafficked in confidential U.S. business information obtained in connection with U.S. participation in the Chemical Weapons Convention?

(yes) (no)

Security and Background: Immigration Law

Violations Information 1

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)

Security and Background: Miscellaneous Information

1

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? (yes) (no)

Have you ever intentionally assisted another person in withholding custody of a U.S. citizen child outside the United States from a person granted legal custody by a U.S. court?

(yes) (no)

Have you voted in the United States in violation of any law or regulation?

(yes) (no)

Have you ever renounced United States citizenship for the purpose of avoiding taxation?

(yes) (no)

Have you attended a public elementary school or a public secondary school on student (F) status after November 30, 1996 without reimbursing the school?

(yes) ( no)

Do you seek to enter the United States for the purpose of performing skilled or unskilled labor but have not yet been certified by the Secretary of Labor?

(yes) (no)

Are you a graduate of a foreign medical school seeking to perform medical services in the United States but have not yet passed the National Board of Medical Examiners examination or its equivalent? (yes) (no)

Security and Background: Miscellaneous Information 2

Are you a health care worker seeking to perform such work in the United States but have not yet received certification from the Commission on Graduates of Foreign Nursing Schools or from an equivalent approved independent credentialing organization? (yes) (no)

Are you permanently ineligible for U.S. citizenship?

(yes) (no)

Have you ever departed the United States in order to evade military service during a time of war?

(yes) (no)

Are you coming to the U.S. to practice polygamy?

(yes) (no)

Are you a former exchange visitor (J) who has not yet fulfilled the two-year foreign residence requirement?

(yes) (no)

Has the Secretary of Homeland Security of the United States ever determined that you knowingly made a frivolous application for asylum?

(yes) (no)

Are you likely to become a public charge after you are admitted to the United States?

(yes) (no)

Social Security Number Information

Have you ever applied for a Social Security number?

（yes）(no)

Do you want the Social Security Administration to issue a Social Security number and a card?

(yes) (no)

Do you authorize disclosure of information from this form to the Department of Homeland Security, the Social Security Administration, and such other U.S. Government agencies as may be required for the purposes of assigning you a social security number (SSN) and issuing you a Social Security card and do you authorize the Social Security Administration to share your SSN with the Department of Homeland Security?

(yes) (no)

If you answer 'No' to this question you will not receive a social security card.