ENTER APPLICANT INFORMATION

The following information is required of every non-immigrant visitor not in possession of a visitor's permit who is a national of one of the VWP countries. Please enter all information requested. Each member of your traveling party must complete a separate application.

Please provide all responses in English.
Required fields are indicated by a red asterisk *.

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APPLICANT / PASSPORT INFORMATION

Refer to your passport and enter all information in the same format.

OTHER CITIZENSHIP/NATIONALITY

Are you now, a citizen or national of any other country?

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Have you ever been a citizen or national of any other country?

ENTER PERSONAL INFORMATION

Please provide all responses in English.
Required fields are indicated by a red asterisk *.

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Are you known by any other names or allases?

Have you ever been issued a passport or national identity card for travel by any other country?

YOUR CONTACT INFORMATION

Please enter your contact information below.

SOCIAL MEDIA (OPTIONAL)

Please enter information associated with your online cresence over the past five vears.

GE/NEXUS/SENTRI MEMBERSHIP

Are you a member of the CBP Global Entry/NEXUS/SENTRI Program?

PARENTS

Please list your parents names in the boxes to the right. Al applicants are required to fill out this section.

EMPLOYMENT INFORMATION

Do you have a curent or previous employer?

ENTER TRAVEL INFORMATION

Please provide all responses in English.
Required fields are indicated by a red asterisk *.

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Is your travel to the US occuring in transit to another country?

ADDRESS WHILE IN THE U.S.

The address where you will be staying in the U.S. is optional to complete the application. If multiple locations are planned, enter the first address. If the complete address is not known, enter the name of the hotel or location you will visit.

Is your Address While in the U.S. same as the U.S. Point of Contact Address listed above?

ELIGIBILITY QUESTIONS

Need additional quidance on eligibility questions?
Required fields are indicated by a red asterisk *.

1) Do you have a physical or mental disorder; or are you a drug abuser or addict, or do you currently have any of the following diseases (communicable diseases are specified pursuant to section 361(b) of the Public Health Service Act):
•Cholera
•Diphtheria
•Tuberculosis, infectious
•Plague
•Smallpox
•Yellow Fever
•Viral Hemorrhagic Fevers, including Ebola, Lassa, Marburg, Crimean-Congo
•Severe acute respiratory illnesses capable of transmission to other persons and likely to cause mortality.

2) Have you ever been arrested or convicted for a crime that resulted in serious damage to property, or serious harm to another person or government authority?

3) Have you ever violated any law related to possessing, using, or distributing illegal drugs?

4) Do you seek to engage in or have you ever engaged in terrorist activities, espionage, sabotage, or genocide?

5) Have you ever committed fraud or misrepresented yourself or others to obtain, or assist others to obtain, a visa or entry into the United States?

6) Are you currently seeking employment in the United States or were you previously employed in the United States without prior permission from the U.S. government?

7) Have you ever been denied a U.S. visa you applied for with your current or previous passport, or have you ever been refused admission to the United States or withdrawn your application for admission at a U.S. port of entry?

8) Have you ever stayed in the United States longer than the admission period granted to you by the U.S. government?

9) Have you traveled to, or been present in Cuba, Iran, Irag, Libya, North Korea, Somalia, Sudan, Syria or Yemen on or after March 1, 2011?

WAIVER OF RIGHTS

I have read and understand that I hereby waive for the duration of my travel authorization obtained via ESTA any rights to review or appeal of a U.S. Customs and Border Protection Officer's determination as to my admissibility, or to contest, other than on the basis of an application for asylum, any removal action arising from an application for admission under the Visa Waiver Program.

In addition to the above waiver, as a condition of each admission into the United States under the Visa Waiver Program, I agree that the submission of biometric identifiers (including fingerprints and photographs) during processing upon arrival in the United States shall reaffirm my waiver of any rights to review or appeal of a U.S. Customs and Border Protection Officer's determination as to my admissibility, or to contest, other than on the basis of an application for asylum, any removal action arising from an application for admission under the Visa Waiver Program.

CERTIFICATION:

I, the applicant, hereby certify that I have read, or have had read to me, all the questions and statements on this application and understand all the questions and statements on this application. The answers and information furnished in this application are true and correct to the best of my knowledge and belief.

THIRD PARTIES ONLY:

For third-parties submitting the application on behalf of the applicant, I hereby certify that I have read to the individual whose name appears on this application (applicant) all the questions and statements on this application. I further certify that the applicant certifies that he or she has read, or has had read to him or her, all the questions and statements on this application, understands all the questions and statements on this application, and waives any rights to review or appeal of a U.S. Customs and Border Protection Officer's determination as to his or her admissibility, or to contest, other than on the basis of an application for asylum, any removal action arising from an application for admission under the Visa Waiver Program. The answers and information furnished in this application are true and correct to the best of the applicant's knowledge and belief.