Please complete the form below to receive your automatic DV-2002 Immigration Lottery Application. When you submit the questionnaire you will only have to follow these three (3) simple steps:
  1. Attach photo to the application.
  2. Sign the application.
  3. Mail it in a standard, size 10 envelope to:

International Immigrants Foundation
1435 Broadway, 2nd Floor
New York, NY 10018
 
APPLICANT

Full Name:

Complete Address:
City:    State:    Zip:

Nation of Birth: Country of Residence:  

Date of Birth: 19

Education: Occupation:


Spouse & Children

Full Name of Spouse:  
Date of Birth: 19   Nation of Birth:
  

Full Name of Child:  
Date of Birth: 19   Nation of Birth:

Full Name of Child:  
Date of Birth: 19   Nation of Birth:

Full Name of Child:  
Date of Birth: 19   Nation of Birth:

Full Name of Child:  
Date of Birth: 19   Nation of Birth: