ELECTRONIC DIVERSITY VISA ENTRY FORM Form: DS-5501 (DV-2021 revision)

Part One - Entrant Information

1. Name
2. Gender
 
 
3. Birth Date
4. City Where You Were Born

Enter Birth City Only. Do not enter District/County/Province/State.

Birth City

5. Country Where You Were Born
6. Country of Eligibility for the DV Program
Your country of eligibility will normally be the same as your country of birth. Your country of eligibility is NOT related to where you live. If you were born in a country that is not eligible for the DV program, please go to Explanation of Country of Eligibility to see if there is another option available in your case.
Are you claiming eligibility based on the country where you were born?
If not, you must enter the country from which you are claiming eligibility
7. Passport
In order to submit an entry for the Diversity Visa program, you must currently possess a valid, unexpired passport from your country of nationality, unless exempt (see below). Please answer A or B.

A) Passport Information

Name On Passport:

Passport Number

Passport Expiration Date:
Country/Authority of Issuance

B) Passport Exemption

I understand that if it is later determined I am not exempt from the passport requirement, I may be disqualified from the Diversity Visa program.
8. Entrant Photograph

Photographs must be submitted at the time of eDV entry. Photographs that do not comply with all specifications, including but not limited to recency of the photos, composition of the photos, and unacceptable backgrounds are grounds for disqualification of the entire entry. Any manipulation of photographs that alters the facial characteristics is grounds for disqualification of the entire entry. See examples on the Photo Examples page.

Please refer to the Instructions for the 2020 Diversity Immigrant Visa program (DV-2020) for technical specifications and compositional specifications for the digital image.

You will use one of the following methods to enter the image into eDV:

  • Take a new digital image,
  • Use a digital scanner to scan a submitted photograph.

Link to Photo Instructions/Photo Examples page

Clicking the 'Choose New Photo' button will allow you to look for and choose the file which is storing the photograph. Once chosen, the file name and the photo will display. If the photo is not correct, please click on the 'Choose New Photo' button to choose a new file.

9. Mailing Address
10. Country Where You Live Today
11. Phone Number
12. E-mail Address
(NOTE: This email address will be used to provide you with additional information if you are selected.)
13. What is the highest level of education you have achieved, as of today?
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://www.onetonline.org/ to see if your occupation qualifies) for a Diversity Visa.
14. What is your current marital status?
Legal separation is an arrangement when a couple remain married but live apart, following a court order. If you and your spouse are legally separated, your spouse will not be able to immigrate with you through the Diversity Visa program. You will not be penalized if you choose to enter the name of a spouse from whom you are legally separated.
If you are not legally separated by a court order, you must include your spouse even if you plan to be divorced before you apply for the Diversity Visa. Failure to list your eligible spouse is grounds for disqualification.
If your spouse is a U.S. citizen or Lawful Permanent Resident, do not list him/her in your entry.
15. Number of Children
Children include all biological children, legally adopted children, and stepchildren who are unmarried and under the age of 21 on the date you submit your entry. You must include all eligible children, even if they do not live with you or if they do not intend to apply for a Diversity Visa as your derivative. Failure to list all eligible children is grounds for disqualification. If your child is a U.S. citizen or Lawful Permanent Resident, do not list him/her in your entry.