ELECTRONIC DIVERSITY VISA ENTRY FORM |
OMB Control Number: 1405-0153
Form: DS-5501
Expires: 05/31/2010
Estimated Burden: 30 minutes
|
|
a. Last/Family Name
Kantsara
|
b. First Name
Valeriy
|
c. Middle Name
Dmitrievich
|
Tuesday, March 17, 1959 |
Male |
|
Ukraine
|
Ukraine |
(Photograph received) |
8a. In Care Of |
Alchevsk
|
8b. Address Line 1 |
Alchevsk
|
8c. Address Line 2 |
Alchevsk
|
8d. City/Town |
Alchevsk
|
8e. District/County/Province/State |
Prospect Metallurgists, 48, Luhansk region
|
8f. Postal Code/Zip Code |
94206
|
8g. Country |
Ukraine
|
(NOTE: This is the address that will be used to notify you if you are selected.) |
|
Ukraine
|
0380644246693
|
d20088002@gmail.ru
|
University Degree
You must have a minimum of a high school diploma reflecting the
completion of a full course of study (vocation schools or equivalency degrees are
not acceptable) or be a skilled worker in an occupation that requires at least two years
of training or experience to qualify (visit
http://online.onetcenter.org/
{this link will open in a new window}
to see if your occupation qualifies) for a Diversity Visa.
|
Married
Legal separation means that a court has formally declared that you and
your spouse are legally separated. Legal separation means that your
spouse would not be eligible to immigrate as your derivative.
|
1
Children include all biological children, legally adopted children, and
stepchildren who are unmarried and under the age of 21 on the date that you
submit your entry. Failure to include all children or inclusion of children
who are not your biological children, legally adopted children, and
stepchildren (regardless of whether they live with you and/or intend to apply
for a visa as your derivative) is grounds for disqualification of the entire entry.
Legal Permanent Residents (LPR) and American Citizens should not be included.
|
|
a. Last/Family Name
Kantsara
|
b. First Name
Zoya
|
c. Middle Name
Ivanovna
|
Tuesday, March 01, 1960 |
Female |
|
Ukraine
|
(Photograph received) |
|
a. Last/Family Name
Kantsara
|
b. First Name
Valeriya
|
c. Middle Name
Valerievna
|
Thursday, June 03, 1993 |
Female |
|
Ukraine
|
(Photograph received) |
|
Please print this page for your personal records. You will need to use your browser's print button for this.
|