DV Lottery Entry Form

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How DV Works
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Contact

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Part One - Entrant Information - Step 1 of 2

1. Name *

First

Middle

Last

2. Gender *

Male
Female

3. Birth Date *

4. City Where You Were Born *

5. Country Where You Were Born *

6. Entrant Photograph *

7. Mailing Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

8. Country Where You Live Today *

9. Phone Number

10. Email Address *

Email

Confirm Email

11. What is the highest level of education you have achieved, as of today? *

Primary school only
High School, no degree
High School degree
Vocational School
Some University Courses
University Degree
Some Graduate Level Courses
Master's Degree
Some Doctorate Level Courses
Doctorate Degree

12. What is your current marital status? *

Unmarried
Married and my spouse is NOT a U.S.citizen or U.S. Lawful Permanent Resident (LPR)
Married and my spouse IS a U.S.citizen or U.S. Lawful Permanent Resident (LPR)
Divorced
Widowed
Legally Separated

13. Number of Children *

12. Spouse Name

First

Middle

Last

12d. Birth Date

12e. Gender

Male
Female

12f. City Where Spouse Was Born

12g. . Country Where Spouse Was Born

12h. Spouse Photograph

13. Child #1 Name

First

Middle

Last

13d. Birth Date

13e. Gender

Male
Female

13f. City Where Child Was Born

13g. . Country Where Child Was Born

13h. Child Photograph

13. Child #2 Name

First

Middle

Last

13d. Birth Date

13e. Gender

Male
Female

13f. City Where Child Was Born

13g. . Country Where Child Was Born

13h. Child Photograph

13. Child #3 Name

First

Middle

Last

13d. Birth Date

13e. Gender

Male
Female

13f. City Where Child Was Born

13g. . Country Where Child Was Born

13h. Child Photograph

13. Child #4 Name

First

Middle

Last

13d. Birth Date

13e. Gender

Male
Female

13f. City Where Child Was Born

13g. . Country Where Child Was Born

13h. Child Photograph

13. Child #5 Name

First

Middle

Last

13d. Birth Date

13e. Gender

Male
Female

13f. City Where Child Was Born

13g. . Country Where Child Was Born

13h. Child Photograph

13. Child #6 Name

First

Middle

Last

13d. Birth Date

13e. Gender

Male
Female

13f. City Where Child Was Born

13g. . Country Where Child Was Born

13h. Child Photograph

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