Last Name: First Name: Date of Birth*: (Month-Day-Year): *This should match the date listed on your passport Current Age: Birthplace: (City, Province) Country of National Identification Number/Tazkira: Marital Status: 2. TEACHING EXPERIENCE: How many years of experience do you have as a full-time university lecturer? DO YOU NOW HAVE, OR HAVE YOU EVER HELD: U.S. CITIZENSHIP? Yes No DO YOU HAVE DUAL CITIZENSHIP WITH ANY OTHER COUNTRY? Yes No DO YOU HAVE U.S. LAWFUL PERMANENT RESIDENCY (GREEN CARD)? Yes No 3. PAST VISA APPLICATIONS: Have you ever applied for the Visa Lottery (Diversity Visa)? If so, please list the year(s) you applied. If someone else has applied on your behalf, or if your spouse or child has applied, please also include that information. Has anyone ever filed an immigrant visa petition on your behalf or on behalf of your spouse or child? If so, list their name, relationship to you and when they filed the petition. Have you, your spouse, or child ever applied for a Special Immigrant Visa? If so, please specify who, when, and what is the current status. Have you ever applied for any other type of visa? If so, please list when, and what was the result. Are you of any factor that might make you ineligible to receive a U.S. visa? If so, please explain. 4. PERMANENT MAILING ADDRESS: Street: City: Province: Country: Telephone: Work Phone: Mobile Phone: E-mail: 5. EMERGENCY CONTACT IN AFGHANISTAN: NAME, ADDRESS, EMAIL AND TELEPHONE NUMBER OF INDIVIDUALS TO BE NOTIFIED IN CASE OF AN EMERGENCY: Name: Phone: E-mail: Relation to you: 6. INFORMATION FAMILY/CONNECTIONS IN UNITED STATES: Please provide Name, Address, E-mail and Telephone number of individual contacts, relatives, or family members in the United States or Canada: 7. Medical, Physical, Dietary or other Personal Considerations: Please state if you have any existing medical conditions or are currently taking any prescription medication. This will not affect candidate selection, but will enable the host institution to make any necessary accommodations.
Last Name: First Name: Date of Birth*: (Month-Day-Year): *This should match the date listed on your passport Current Age: Birthplace: (City, Province) Country of National Identification Number/Tazkira: Marital Status: 2. TEACHING EXPERIENCE: How many years of experience do you have as a full-time university lecturer? DO YOU NOW HAVE, OR HAVE YOU EVER HELD: U.S. CITIZENSHIP? Yes No DO YOU HAVE DUAL CITIZENSHIP WITH ANY OTHER COUNTRY? Yes No DO YOU HAVE U.S. LAWFUL PERMANENT RESIDENCY (GREEN CARD)? Yes No 3. PAST VISA APPLICATIONS: Have you ever applied for the Visa Lottery (Diversity Visa)? If so, please list the year(s) you applied. If someone else has applied on your behalf, or if your spouse or child has applied, please also include that information. Has anyone ever filed an immigrant visa petition on your behalf or on behalf of your spouse or child? If so, list their name, relationship to you and when they filed the petition. Have you, your spouse, or child ever applied for a Special Immigrant Visa? If so, please specify who, when, and what is the current status. Have you ever applied for any other type of visa? If so, please list when, and what was the result. Are you of any factor that might make you ineligible to receive a U.S. visa? If so, please explain. 4. PERMANENT MAILING ADDRESS: Street: City: Province: Country: Telephone: Work Phone: Mobile Phone: E-mail: 5. EMERGENCY CONTACT IN AFGHANISTAN: NAME, ADDRESS, EMAIL AND TELEPHONE NUMBER OF INDIVIDUALS TO BE NOTIFIED IN CASE OF AN EMERGENCY: Name: Phone: E-mail: Relation to you: 6. INFORMATION FAMILY/CONNECTIONS IN UNITED STATES: Please provide Name, Address, E-mail and Telephone number of individual contacts, relatives, or family members in the United States or Canada: 7. Medical, Physical, Dietary or other Personal Considerations: Please state if you have any existing medical conditions or are currently taking any prescription medication. This will not affect candidate selection, but will enable the host institution to make any necessary accommodations.
AJFDP2016_002.docx