GREEN CARD LOTTERY
(DV-2005)
NOVEMBER 1, 2003 AND TUESDAY, DECEMBER
30, 2003
1. FULL NAME [Last, First, Middle]
2. DATE OF BIRTH [ Day, Month, Year]
3. GENDER [Male or Female]
4. CITY/TOWN
OF BIRTH
5. COUNTRY OF BIRTH
6. APPLICANT
PHOTOGRAPH [ 2" x 2" ] JPG
FORMAT light colored background *1
7. MAILING ADDRESS [City/Town, District/Country/Province/State,
Postal Code/Zip Code, Country]
8. PHONE
NUMBER
9. E-MAIL ADDRESS
10. COUNTRY
OF ELIGIBILITY [If
the appicants country is different from cuntry of birth]
11. MARRIAGE STATUS
[Yes
/ No]
12. NUMBER
OF CHILDREN [Unmarried and 21 years
of age]
13. SPOUSE INFORMATION [
Name, DOB, Gender, City/Town of Birth, Country of Birth, Photograph
]
14. CHILDREN
INFORMATION [Name, Date of Birth,
Gender, City/Town of Birth, Country of Birth, Photograph]
15. EDUCATIN / EXPERIENCE [High
school - 12 years or 2 years job experience required ]
Please Click send button once.