DV Lottery Application Checklist
Part One - Entrant Information
Name:
Last/Family Name
First Name
Middle Name (if applicable)
Gender
Birth Date:
Day
Month
Year
City Where You Were Born
Country Where You Were Born
Country of Eligibility for the DV Program
Entrant Photograph
Recent passport-size photo
Mailing Address:
Address Line 1
Address Line 2 (if applicable)
City/Town
District/County/Province/State
Postal Code/Zip Code
Country
Country Where You Live Today
Phone Number: (optional)
E-mail Address:
An email address that will be used for additional information if selected.
Highest Level of Education Achieved:
Make sure to have documentation supporting the highest level of education completed.
Current Marital Status:
Married and my spouse is NOT a U.S. citizen or U.S. Lawful Permanent Resident (LPR)
Legal separation documents if applicable
Number of Children:
List of all biological children, legally adopted children, and stepchildren who are unmarried and under the age of 21
Part Two - Derivatives
Spouse Information:
Spouse Name:
Last/Family Name
First Name
Middle Name (if applicable)
Birth Date
Gender
City Where Spouse Was Born
Country Where Spouse Was Born
Spouse Photograph: Recent passport-size photo
Child #1 Information:
Child Name:
Last/Family Name
First Name
Middle Name (if applicable)
Birth Date
Gender
City Where Child Was Born
Country Where Child Was Born
Child Photograph: Recent passport-size photo
Child #2 Information:
Child Name:
Last/Family Name
First Name
Middle Name (if applicable)
Birth Date
Gender
City Where Child Was Born
Country Where Child Was Born
Child Photograph: Recent passport-size photo
Child #3 Information:
Child Name:
Last/Family Name
First Name
Middle Name (if applicable)
Birth Date
Gender
City Where Child Was Born
Country Where Child Was Born
Child Photograph: Recent passport-size photo
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