Intake form · US DS-160 (B1/B2), ESTA

US Visitor Visa / ESTA Intake Form

Need a US visa or ESTA from Canada? Share your trip, travel and work history and we'll help you prepare your DS-160 B1/B2 visa or ESTA application.

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This is an information form only. Fill in whatever you know to the best of your knowledge. Every question is optional, so skip anything you're unsure about. We'll call or message you for the rest.

Your contact details

Full name *

Email *

Mobile number with country code *

Section 1 · Personal

Personal details

Other names used (maiden name, nickname, alias)

Sex

Date of birth

Place of birth (city and country)

Section 2 · Marital status

Marital status

Current marital status

Date of marriage or start of common-law relationship

Spouse or partner's first name

Spouse or partner's last name

Section 3 · Passport

Passport

Passport number

Country that issued the passport

Passport issue date

Passport expiry date

Section 4 · Contact

Contact information

Current address where documents can be mailed (with postal code)

Section 5 · US trip

Your trip to the United States

What do you need?

Purpose of the trip

Planned arrival date and length of stay

Address where you will stay in the US

Who is paying for the trip?

Previous US visits and visas (dates, visa type)

Have you ever been refused a US visa or entry?

Contact person in the US (name, phone)

Your status in Canada

Section 6 · Education

Education

Highest level of education

Your highest education

Row 1

From

Program / field of study

School name

City and country

Section 7 · Employment

Employment (last 5 years)

List everything with no gaps. If you were unemployed, studying or at home for a period, add a row for that too.

Current occupation

Jobs, studies and gaps (start with the most recent, include unemployed periods)

Row 1

From

Job title / activity

Employer or school

City and country

Hours per week

Row 2

From

Job title / activity

Employer or school

City and country

Hours per week

Section 8 · Background

Background information

In the last 2 years, have you or a family member had tuberculosis or been in close contact with someone who has?

Do you have any physical or mental condition that needs social or health services?

Have you ever stayed beyond your permitted time, studied or worked without permission in Canada?

Have you ever been refused a visa or permit, denied entry, or ordered to leave any country?

Have you applied to enter or stay in Canada before?

Have you ever committed, been arrested, charged or convicted of any offence in any country?

Have you served in any military, militia, civil defence or police unit?

Have you been a member of a political party or group that used violence?

If you answered yes to any question above, explain briefly

Section 9 · Other

Anything else

Anything else we should know