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Green Card Lottery Application : Electronic Diversity VISA Entry FORM
SINGLE Married No Child Married 1 Child Married 2 Children Married 3 Children Married 4 Children

Part One - Entrant Information

1. Name

a. Last/Family Name

No Last/Family Name
b. First Name

No First Name
c. Middle Name

No Middle Name

2. Birth Date

3. Gender

Male Male
Female Female

4. City Where You Were Born

Birth City/Town Unknown

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.

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. Entrant Photograph

Photographs must be submitted at the time of E-DV 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.

Please refer to the Instructions for the 2008 Diversity Immigrant Visa Program (DV-2008) 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 validation page {this link will open in a new window}

Photograph File Name

If you know the location in the computer and the name of the file which is storing the photograph, enter in the box to the left of the 'Browse' button. If you are not sure of the location in the computer or the name of the file, clicking the 'Browse' button will allow you to look for and choose the file which is storing the photograph, and after you choose the file its name will appear in the box above.

8. Mailing Address

8a. In Care Of (Full Name of Recipient)
8b. Address Line 1
8c. Address Line 2
8d. City/Town
8e. District/County/Province/State
8f. Postal Code/Zip Code No Postal Code/Zip Code
8g. Country
(NOTE: This is the address that will be used to notify you if you are selected.)

9. Country Where You Live Today

10. Phone Number

11. E-mail Address

Electronic delivery of DV correspondence may be offered in the near future. Please enter an email address in the box below if you would prefer to receive correspondence electronically.

12. What is the highest level of education you have achieved, as of today?

Primary School OnlyUniversity Degree
High School, no DegreeSome Graduate Level Courses
High School DegreeMaster Degree
Vocational SchoolSome Doctorate Level Courses
Some University CoursesDoctorate 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 {this link will open in a new window} to see if your occupation qualifies) for a Diversity Visa.

13. What is your current marital status?

Unmarried (no spouse info required)
Married (spouse info required)
Divorced (no spouse info required)
Widowed (no spouse info required)
Legally Separated (no spouse info required)

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.

14. 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 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.

Payment Information : Single : USD$ 40.00 // Family : USD$ 75.00
We will total your order for you ... scroll down to complete your order.

Full Name of Credit Card Holder :
Phone Number :
(in case we have a question about your order)

Category :

Single : USD$ 40.00

Family USD$ 75.00

Card Type :

Card Number :

EXP. DATE (mm/yyyy) :

Card Verification Number :
(On the back of your card, find the last 3 digits)

E-Mail All Information Needed to "" If You Unable To Send This Application Form.