Security and Background.
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 other diseases as determined by the Department of Health and Human Services.)
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
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 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 committed, or conspired to commit a severe human trafficking offense in the United States or outside the United States?
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
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 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
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
Have you ever been directly involved in the coercive transplantation of human organs or bodily tissue?
Yes No
Have you ever been the subject of a removal or deportation hearing?
Yes 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
Have you failed to attend a hearing on removability or inadmissibility within the last five years?
Yes 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
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 voted in the United States in violation of any law or regulation?
Yes No
Have you ever renounced United States citizenship for the purposes of avoiding taxation?
Yes 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
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