OMB APPROVAL NO. 1405-0098
EXPIRATION DATE 3/31/98
ESTIMATED BURDEN: 30 minutes
U.S. DEPARTMENT OF STATE
SUPPLEMENTAL REGISTRATION FOR
THE DIVERSITY IMMIGRANT VISA PROGRAM
The following is a supplemental registration form for the Diversity Immigrant Visa Program under Section 203 (c) of the Immigration and
Clearly print or type all answers in the English language. Answer all questions.
Using the enclosed self-adhesive return address label, immediately send this form along with Forms OF-230 Parts I & II to: Diversity Immigrant
Visa Program, National Visa Center, 32 Rochester Avenue, Portsmouth, NH 03801-2909, USA. Failure to follow instructions will disqualify
You will be notified by mail of your appointment date, therefore the answer to question No. 3 must be accurate.
1. NAME (Last Name)
2. RANK ORDER NUMBER (case number on envelope)
3. CURRENT MAILING ADDRESS (Address at which you receive your mail. Give any change of mailing address here.)
Telephone Number (Optional):
4. NAME OF UNITED STATES IMMIGRANT VISA ISSUING CONSULAR OFFICE TO WHICH YOUR VISA APPLICATION
SHOULD BE SENT.
Ordinarily, this will be the immigrant visa issuing consular office nearest your place of residence. If you do not
know which office, list the city and country of your current residence abroad, or the city and country of your last previous residence
outside the United States.
5. NATIVE COUNTRY AND ALTERNATE FOREIGN STATE CHARGEABILITY
"Native Country" generally refers to your country of birth. Under Section 202(b) of the Immigration and Nationality Act, however, you
may also claim the country of birth of your spouse. In addition, you may claim the country of birth of either of your parents if you were
born in a country in which neither parent was a native or resident at the time of birth. If you make such a claim, list your claimed native
a. I am a high school graduate.
Year of Graduation
b. I have the equivalent of a high school education.
c. Check highest level of education completed.
High School, No Degree
High School Diploma
College, No Degree
d. Names and addresses of all schools, colleges, and universities attended (include trade and vocational schools):
NAME AND EDUCATIONAL INSTITUTION
DEGREE(S) OR CERTIFICATE(S) RECEIVED