Form DS-157 Supplemental NonImmigrant Visa Form

U.S. Department of State

SUPPLEMENTAL NONIMMIGRANT VISA APPLICATION

Approved OMB 1405-0134
Expires 09/30/2008
Estimated Burden 1 Hour*

PLEASE TYPE OR PRINT YOUR ANSWERS IN THE SPACE PROVIDED BELOW EACH ITEM
PLEASE ATTACH AN ADDITIONAL SHEET IF YOU NEED MORE SPACE TO CONTINUE YOUR ANSWERS
1. Last Name(s) (List all Spellings)

2. First Name(s) (List all Spellings)

3. Full Name (In Native Alphabet)

4. Clan or Tribe Name (If Applicable)

5. Spouse's Full Name (If Married)

6. Father's Full Name

7. Mother's Full Name

8. Full Name and Address of Contact Person or Organization in the United States (Include Telephone Number)

10. List All Countries That Have Ever Issued You a
Passport

9. List All Countries You have Entered in the Last Ten Years
(Give the Year of Each Visit)

11. Have you ever lost a
passport or had one
stolen?
Yes

12. Not Including Current Employer, List Your Last Two Employers
Telephone Number
Name
Address

13. List all Professional, Social and Charitable Organizations to Which You
Belong (Belonged) or Contribute (Contributed) or with Which You Work
(Have Worked).

15. Have you ever performed military service?
Name of Country

Yes

Branch of Service

Job Title

Supervisor's Name

16. Have you ever been in an armed conflict, either as a participant or victim?

Dates of Employment (mm-dd-yyyy)
From
To

Military Specialty

Yes

No

If YES, please explain.

17. List all educational institutions you attend or have attended. Include vocational institutions but not elementary schools.
Address/Telephone Number
Name of Institution
Course of Study

18. Have you made specific travel arrangements?

Yes

No

Dates of Employment (mm-dd-yyyy)
From
To

14. Do you have any specialized skills or training, including firearms,
explosives, nuclear, biological, or chemical experience?
No
If YES, please explain
Yes

No If yes, complete below.
Rank/Position

No

Dates of Attendance (mm-dd-yyyy)
From
To

If YES, please provide a complete itinerary for your travel, including arrival/departure
dates, flight information, specific location you will visit, and a point of contact at each
location.

Paperwork Reduction Act Statement
Public reporting burden for this collection of information is estimated to average 1 hour 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: U.S. Department of State, A/ISS/DIR, 1800 G St. NW, Washington, DC 20520

DS-157
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