Washington State University

Date:
1972-1973
Reference:
PP/CRI/E/1/21/7
Catalogue details

Licence: In copyright

Credit: Washington State University. Source: Wellcome Collection.

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    SS READ THIS PARAGRAPH AND CHECK YES or NO THIS APPLICATION FORM IS SUPPLIED GRATIS VISITOR VISA APPLICATION 0! O X IMPORTANT NOTE: ( 1 ) U.S. law prohibits issuance of a visitor visa to persons who plan to remain indefinitely in the U.S., or who will accept employment there. A visitor may noi work. (2) A visa may not be issued to persons who are within specific categories defined by law as inadmissible into the U.S. (except when a waiver is obtained in advance). Complete information as to the categories and whether any may be applicable to you can be obtained from this office, (a) Generally, they include persons afflicted with contagious diseases (such as tuberculosis) or who have suffered serious mental illness; persons with criminal records involving offenses of certain kinds including offenses against public morals; narcotic addicts, or traffickers, (b) Also, a visa may not be issued to persons who have sought to obtain one by means of a misrepresentation, (c) U.S. law also prohibits the issuance of a visa without a waiver to members of certain organizations, including communist organizations and those affiliated therewith. Do any of the foreg o you? Yes □ No □ APPLICANTS SHOULD PRINT THE FOLLOWING INFORMATION PASSPORT NO DATE OF ISSUE ISSUED BY EXPIRES ON 1. FAMILY NAME GIVEN NAME MIDDLE NAME 3. NATIONALITY 5. DATE OF BIRTH (Month, Day, V 4. PLACE OF BIRTH (City. State. Country) 6. RESIDENTIAL ADDRESS (Includa apartment no. and post zona) 7. TELEPHONE AT RESIDENCE 8. OFFICE, WORK LOCATION, SCHOOL ADDRESS 9. TELEPHONE NO. 12. COLOR OF HAIR 13. COLOR OF EYES 14. HEIGHT 15. COMPLEXION (fair, ruddy, oli ve. etc.) 16. MARKS OF IDENTIFICATION (Visible Scan. Moles) 17. MARITAL STATUS □ Married □ Single □ Widowed □ Divorced 18. WHAT IS THE PURPOSE OF YOUR TRIP, THE LENGTH OF STAY AND ADDRESS IN THE USA? 19. WHEN DO YOU INTEND TO DEPART FOR YOUR STAY IN 20. DO YOU INTEND TO WORK IN THE USA? THE USA? D Yes □ No THIS APPLICATION FORM IS SUPPLIED GRATIS FORM FS 257a (English) 1/72