DV 2011 Lottery - Application

Instructions and Application: Please fill out the below information and return it along with the application (see below) to this office:

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GREEN CARD LOTTERY APPLICATION

Please type or write in clear and legible print and return this application with 2 digital photos (See below) of the applicant and his/her spouse(if applicable) and each child(if applicable) (size of photo: 2 inches [50mm] square) and the signature of each adult applicant in your family. To file this on time, I MUST RECEIVE THE APPLICATION NO LATER THAN Friday, November 27, 2009. On the application, please note that, with very few exceptions, your native country is your country of birth (see page 3 for notes on basic eligibility). The fee is $50 for each applicant. The U.S. Government will award 55,000 Green Cards to randomly selected persons. The fee only includes the cost of attorney assistance in filing your lottery application and the cost of notifying you by mail that it has been properly filed and then of the results when all winners are announced by the end of July 2010. The government will grant DV-2011 visas between October 1, 2010 and September 30, 2011. If otherwise qualified, a husband and a wife may each submit one application for registration. If either one wins the other could claim derivative status at the time of the green card application. Note: the spouses may not sign for each other, i.e. the husband must sign his application and the wife must sign hers. If a child has met the requirement of a high school education at the time of entry registration he can apply on his own application.

PHOTOGRAPHS:

• Each applicant must submit a digital photograph (image) for the Application.
• Please email your digital photographs to the email address at the top of this page. Please label each photo in the subject line of the email so that I may identify the subject of the photo.
• FAILURE TO ENTER THE CORRECT PHOTOGRAPH OF EACH INDIVIDUAL IN THE CASE INTO THE E-DV SYSTEM WILL RESULT IN DISQUALIFICATION OF THE PRINCIPAL APPLICANT AND REFUSAL OF ALL VISAS IN THE CASE AT THE TIME OF THE INTERVIEW. You must submit recent photographs of the applicant and his/her spouse and each child under 21 years of age, including all natural children as well as all legally-adopted and stepchildren, even if a child no longer resides with you or you do not intend for a child to immigrate under the DV program. You do not need to submit a photograph for a child who is already a U.S. citizen or a Legal Permanent Resident. Group or family photos will not be accepted; you must submit a separate photo for each family member.

Each applicant, his/her spouse, and each child will therefore need a computer file containing his/her digital photo (image) which this office will submit on-line with the EDV Entry Form. The Applicant can produce the image file either by taking a new digital photograph or by scanning a photographic print with a digital scanner.

If the submitted digital images do not conform to the following specifications, the system will automatically reject the EDV Entry Form and notify the sender.
• The image must be in the Joint Photographic Experts Group (JPEG) format.
• The image must be either in 24-bit color (black and white, monochrome or greyscale images not accepted)
• If a new digital photograph is taken, it must have a resolution of 600 pixels wide by 600 pixels high, and a color depth of 24-bit color.
• If the Applicant scans a photographic print, the print must be 2 inches by 2 inches (50mm x 50mm) square. It must be scanned at a resolution of 150 dots per inch (dpi) and with a color depth of either 24-bit color, 8-bit color, or 8-bit grayscale.
• The maximum image size accepted will be sixty-two thousand five hundred (62,500) bytes.

If the submitted digital images do not conform to the following specifications, the entry will be disqualified:
• Applicant, spouse, or child must be directly facing the camera; the head of the person being photographed should not be tilted up, down or to the side, and should cover about 50% of the area of the photo.
• The photo should be taken with the person being photographed in front of a neutral, light-colored background. Photos taken with very dark or patterned, busy backgrounds will not be accepted.
• Photos in which the face of the person being photographed is not in focus will not be accepted.
• Photos in which the person being photographed is wearing sunglasses or other paraphernalia which detracts from the face will not be accepted.
• Photos of applicants wearing head coverings or hats are only acceptable due to religious beliefs, and even then, may not obscure any portion of the face of the applicant.
• The U.S. Department of State will not accept the following:
1. Photos of applicants with tribal or other headgear not specifically religious in nature are not acceptable.
2. Photos of military, airline or other personnel wearing hats

Enclosed is a U.S. $ check, money order, or cash payable to John M Manley for $

I have wired $

(If you would like to use this option, please contact this office first)

Credit card: Type (Visa, Mastercard, American Express)

Credit card number Expiration Date

Level of Education (Describe how many years of school from age six and all diplomas and degrees):

Occupation (Describe your job and profession for the past ten years. If possible, attach a curriculum vitae/resume):

Mailing Address:

Permanent Address, if different:

Telephone: (Home:) (Work:)

(Fax:) (Email:)

Sex (Male or Female):

Marital Status (single, married, divorced, widowed):

Citizenship:

Relatives in the United States (Parents, grandparents, spouse, children, brothers, sisters, aunts, uncles, cousins...also state whether the relative is a citizen or a permanent resident):

ELIGIBILITY:

Every applicant must have at least a high school education or its equivalent(defined in the U.S. as successful completion of a 12-year course of elementary and secondary education) OR, within the past five years, have two years of work experience in an occupation requiring at least two years training or experience.
For DV-2011, natives of the following countries are not eligible to apply because they sent a total of more than 50,000 immigrants to the U.S. in the previous five years:

BRAZIL, CANADA, CHINA (mainland-born), COLOMBIA, DOMINICAN REPUBLIC, ECUADOR, EL SALVADOR, GUATEMALA, HAITI, INDIA, JAMAICA, MEXICO, PAKISTAN, PHILIPPINES, PERU, POLAND, SOUTH KOREA, UNITED KINGDOM (except Northern Ireland) and its dependent territories, and VIETNAM.

Persons born in Hong Kong SAR, Macau SAR and Taiwan are eligible.

However, applicants born in these countries may claim chargeability to the country of birth of a spouse; a minor dependent child can be charged to the country of birth of a parent; and an applicant born in a country of which neither parent was a native or a resident at the time of his/her birth may be charged to the country of birth of either parent.
Successful applicants who are already in the United States and wish to adjust status to Permanent Residency in the United States must have maintained their visas in lawful status at all times.

DV-2011

1.  NAME:

(Last:)                          (First:)                   (Middle:)

2.  DATE OF BIRTH:

(Day:)                           (Month:)                   (Year:)

3.  GENDER:  Male or Female

4.  PLACE OF BIRTH:

(City:)                          (State:)                   (Country:)                

5.  COUNTRY OF ELIGIBILITY IF THE APPLICANT’S NATIVE COUNTRY IS DIFFERENT FROM COUNTRY OF BIRTH:

(City:)                          (State:)                   (Country:)         

6.  COUNTRY WHERE YOU LIVE TODAY:

7. WHAT IS THE HIGHEST LEVEL OF EDUCATION YOU HAVE ACHIEVED, AS OF TODAY (circle one)? You must indicate which one of the following represents your own highest level of educational achievement:

(1) Primary School only, (2) High School, no degree, (3) High School degree, (4) Vocational School, (5) Some University courses, (6) University degree, (7) Some graduate level courses, (8) Master's degree, (9) some doctorate level courese, (10) Doctorate Degree

8. WHAT IS YOUR MARITAL STATUS (Circle One)?

UNMARRIED (NO SPOUSAL INFORMATION REQUIRED)

MARRIED (SPOUSAL INFORMATION REQUIRED)

WIDOWED (NO SPOUSAL INFORMATION REQUIRED)

LEGALLY SEPARATED (NO SPOUSAL INFORMATION REQUIRED)

8.  NUMBER OF CHILDREN THAT ARE UNMARRIED AND UNDER 21 YEARS OF AGE:

8.  NAME, GENDER, DATE AND PLACE OF BIRTH OF THE APPLICANT’S SPOUSE (IF ANY)

9.  NAME, GENDER, DATE AND PLACE OF BIRTH OF THE APPLICANT’S CHILDREN (IF ANY)

Attach information on additional children as necessary

    Signature