Name:           

Mailing Address:


City:  State: 
 Zip: 

Country:        

Nationality:    

Phone numbers:  


E-mail:  


Desired Visa Status:


Last entered U.S.:


Current Visa Status:


Date current visa status will expire?


Status of other relatives and family members:
(For example: any relatives already residing in the U.S.?)


Education and specialized experience (if any):


Occupation and work experience:


Please tell us in your own words what it is that you
wish to accomplish by contacting us:


Other comments:

Before submitting this questionnaire, please make sure that you have provided us with all the information requested. Thank you !