DS-157 Supplemental NonImmigrant Visa Form

U.S. Department of State

SUPPLEMENTAL NONIMMIGRANT VISA APPLICATION

Approved OMB 1405-0134
Expires 11/30/2011
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)

9. List all countries you have entered in the last ten years.
(Give the year of each visit)

10. List all countries that have ever issued you a passport.

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

Yes

No

12. Not including current employer, list your last two employers.
Name

Address

Telephone Number

Job Title

13. List all professional, social and charitable organizations to which you belong
(belonged) or contribute (contributed) or with which you work (have worked).

Name of Country

Yes

Dates of Employment
(mm-dd-yyyy) or "Present"
From
To

14. Do you have any specialized skills or training, including firearms,
explosives, nuclear, biological, or chemical experience?
Yes

15. Have you ever performed military service?

Supervisor's Name

No

If YES, please explain.

No If yes, complete below.

Branch of Service

Rank/Position

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

Military Specialty

Yes

No

Dates of Service
(mm-dd-yyyy) or "Present"
From
To

If YES, please explain.

17. List all educational institutions you attend or have attended. Include vocational institutions but not elementary schools.
Name of Institution

Address

Telephone Number

Course of Study

Dates of Attendance
(mm-dd-yyyy) or "Present"
From
To

18. Have you made specific travel arrangements?
No
Yes
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.

CONFIDENTIALITY AND PAPERWORK REDUCTION ACT STATEMENTS
Confidentiality Statement - INA Section 222(f) provides that visa issuance and refusal records 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 visa records may be made available to a court which certifies that the information contained in such records is
needed in a case pending before the court.

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: A/GIS/DIR, Room 2400 SA-22, U.S. Department of State,
Washington, DC 20522-2202

DS-157
08-2011