Green Card Lottery Center

STEP 1 - COMPLETE YOUR REGISTRATION FORM

Please answer all the questions in ENGLISH.

1. APPLICANT INFORMATION
Your First name
Your Last name
Sex: Male Female

2. COMPLETE MAILING ADDRESS:
Street
City State: Zip Code:
Country
Telephone
Fax
Email Address

3. ELIGIBILITY INFORMATION

Hi-School Graduate?
Year Graduated Hi-School:
Years of experience in your Occupation: : years

Date of Birth: , 19xx
Place of Birth: City
Place of Birth: Providence/state
Place of Birth: Country

If you were NOT born in a "LOTTERY ELIGIBLE COUNTRY" Follow these instructions in filling in the next box.  It is important that this information is filled in properly.

  • Enter YOUR Country of Birth if you were born in a "Lottery Eligible Country"
  • Enter your SPOUSE'S Country of Birth if you were born in an ineligible country, and your spouse was born in a "Lottery Eligible Country"
  • Enter either of YOUR or your SPOUSES PARENT'S Country of Birth if both you and your spouse were born in an ineligible country, but any one of your PARENTS were born in a "Lottery Eligible Country"
    Country on which your eligibility will be based:

4. SPOUSE (HUSBAND OR WIFE)
Spouse First name
Spouse Last name
Spouse Date of Birth: Month: ,
Spouse Place of Birth: City
Spouse Place of Birth: Providence/state
spouse Place of Birth: Country

5. UNMARRIED CHILDREN UNDER 21 YEARS OLD

First Name
Last Name
Date of Birth
MM/DD/YYYY
Country of Birth
Child 1
Child 2
Child 3
Child 4
Child 5
6. SECURITY
Password
Confirm Password
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