6/2/23, 12:15 AM Consular Electronic Application Center - Print Application

Online Nonimmigrant Visa Application (DS-160)

Application - Sensitive But Unclassified(SBU)

We do not need a printed copy of your application at any point during your interview process. Only print this
application if you want a copy for your own records. If you print your application, please keep it secure.

Photo Provided:

Confirmation Number:

Your Personal Copy -- Do Not Bring to Interview

Personal, Address, Phone, and Passport/Travel Document Information
Name Provided: BHIKADIYA, PRAGNESH DINESHBHAI

Full Name in Native Language: DOES NOT APPLY

Other Names Used: NO

Telecode Name Used: NO

Sex: MALE

Marital Status: MARRIED

Date of Birth: 07 NOVEMBER 1996

Place of Birth: CHADA, GUJARAT, INDIA

Country/Region of Origin (Nationality): INDIA

Do you hold or have you held any nationality other than the one NO
indicated above on nationality?

Are you a permanent resident of a country/region other than your NO

country/region of origin (nationality) above?

National Identification Number: DOES NOT APPLY

U.S. Social Security Number: DOES NOT APPLY

U.S. Taxpayer ID Number: DOES NOT APPLY

Home Address: 40 - MADHAV KUNJ SOC. NR. SHARDA SCHOOL

SINGANPORE - CAUSEWAY ROAD

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City: SURAT

State/Province: GUJARAT

Postal Zone/ZIP Code: 395004

Country/Region: INDIA

Same Mailing Address? YES

Primary Phone Number: 09104432649

Secondary Phone Number: DOES NOT APPLY

Work Phone Number: DOES NOT APPLY

Do you have any additional phone numbers? NO

Email Address: [email protected]

Do you have any additional email addresses? NO

Do you have a social media presence?

Social Media Platform: (1): INSTAGRAM

Social Media Identifier: PRAGNESHBHIKADIYA

Do you have any additional social media presence? NO

Passport/Travel Document Type: REGULAR

Passport/Travel Document Number: W0682935

Passport Book Number: DOES NOT APPLY

Country/Authority that Issued Passport/Travel Document: INDIA

City Where Issued: SURAT

Country/Region Where Issued: INDIA

Issuance Date: 26 JULY 2022

Expiration Date: 25 JULY 2032

Have you ever lost a passport or had one stolen? NO

Travel Information
The List of Purposes of Trip to the U.S.

Purpose of Trip to the U.S. (1): ACADEMIC OR LANGUAGE STUDENT (F)

Specify: STUDENT (F1)

Have you made specific travel plans? NO

Intended Date of Arrival: 17 JULY 2023

Intended Length of Stay in U.S.: 2 YEAR(S)

Address where you will stay in the U.S.: OFFICE OF GLOBAL EDUCATION ISSS

Person/Entity Paying for Your Trip: OTHER PERSON

Person Paying for Your Trip: BHIKADIYA , DINESHBHAI RAGHAVBHAI

Telephone Number: 09377792017

Email Address: DOES NOT APPLY

Relationship to You: PARENT

Is the address of the party paying for your trip the same as your Home YES
or Mailing Address?

Are there other persons traveling with you? NO

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Have you ever been in the U.S.? NO

Have you ever been issued a U.S. visa? NO

Have you ever been refused a U.S. Visa, or been refused admission to NO
the United States, or withdrawn your application for admission at the
port of entry?

Has anyone ever filed an immigrant petition on your behalf with the NO
United States Citizenship and Immigration Services?

U.S. Contact Information

Contact Person Name in the U.S.: HUTZELL, BARBARA

Organization Name in the U.S.: KENT STATE UNIVERSITY

Relationship to You: SCHOOL OFFICIAL

U.S. Contact Address: OFFICE OF GLOBAL EDUCATION ISSS PO

BOX 5190

KENT , OHIO 44242

Phone Number: 03303393391

Email Address: [email protected]

Family Information
Father's Surnames: BHIKADIYA

Father's Given Names: DINESHBHAI RAGHAVBHAI

Father's Date of Birth: 15 JULY 1971

Is your father in the U.S.? NO

Mother's Surnames: BHIKADIYA

Mother's Given Names: ANITABEN DINESHBHAI

Mother's Date of Birth: 01 JUNE 1973

Is your mother in the U.S.? NO

Do you have any immediate relatives, not including parents in the U.S.? NO

Do you have any other relatives in the United States? NO

Spouse's Full Name: BHIKADIYA, TARALBEN PRAGNESH

Spouse's Date of Birth: 22 JANUARY 1998

Spouse's Country/Region of Origin (Nationality): INDIA

Spouse's City of Birth: SURAT

Spouse's Country/Region of Birth: INDIA

Spouse’s Address: SAME AS HOME ADDRESS

Work/Education/Training Information
Primary Occupation: OTHER

Specify Other: I AM WORKING IN AIRLINES.

Present Employer or School Name: STAR AIR GHODAWAT ENTERPRISES PVT LTD

Address: SURAT INTERNATIONAL AIRPORT

MAGDALA ROAD GAVIYER

City: SURAT

State/Province: GUJARAT

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Postal Zone/Zip Code: 395007

Country/Region: INDIA

Work Phone Number: 08956347035

Monthly Salary in Local Currency (if employed): DOES NOT APPLY

Briefly Describe your Duties: I AM WORKING AS A AIRCRAFT MAI

NTENANCE JUNIOR TECHNICIAN IN
THAT COMPANY.

Were you previously employed? YES

Employer Name (1): AIR INDIA

Employer Address: AIR INDIA OLD AIRPORT,

KALINA

SANTACRUZ

City: MUMBAI

State/Province: MAHARASHTHA

Postal Zone/Zip Code: 400029

Country/Region: INDIA

Telephone Number: 026265555

Job Title: AIRCRAFT MAINTENANCE

TRAINING

Supervisor's Surname: DO NOT KNOW

Supervisor's Given Name: DO NOT KNOW

Employment Date From: 20 MARCH 2017

Employment Date To: 19 SEPTEMBER 2017

Briefly describe your duties: I WORKED AS A

AIRCRAFT MAINTEN
ANCE TRAINING IN THAT
COMPANY.

Employer Name (2): INDIGO AIRLINES

Employer Address: SURAT INTERNATIONAL

AIRPORT MAGDALA

ROAD GAVIYER

City: SURAT

State/Province: GUJARAT

Postal Zone/Zip Code: 395004

Country/Region: INDIA

Telephone Number: 01244352500

Job Title: AIRCRAFT MAINTENANCE

JUNIOR TECHNICIAN

Supervisor's Surname: DO NOT KNOW

Supervisor's Given Name: DO NOT KNOW

Employment Date From: 13 NOVEMBER 2018

Employment Date To: 24 JULY 2020

Briefly describe your duties: I WORKED AS A AIRCRAT

MAINTENA
NCE JUNIOR TECHNICIAN

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IN THAT
COMPANY.

Have you attended any educational institutions at a secondary level or YES

above?

Name of Institution (1): SINGHANIA UNIVERSITY

Address of Institution: SINGHANIA UNIVERSITY PANCHERI BARI

City: JHUNJHUNU

State/Province: RAJASTHAN

Postal Zone/ZIP Code: 333515

Country/Region: INDIA

Course of Study: BACHELOR IN AIRCRAFT MAINTENNACE

ENGINEERING

Date of Attendance From: 15 JUNE 2021

Date of Attendance To: 12 DECEMBER 2021

Do you belong to a clan or tribe? NO

Provide a List of Languages You Speak:

Language Name (1): GUJARATI

Language Name (2): HINDI

Language Name (3): ENGLISH

Have you traveled to any countries/regions within the last five years? NO

Have you belonged to, contributed to, or worked for any professional, NO
social, or charitable organization?

Do you have any specialized skills or training, such as firearms, NO

explosives, nuclear, biological, or chemical experience?

Have you ever served in the military? NO

Have you ever served in, been a member of, or been involved with a NO
paramilitary unit, vigilante unit, rebel group, guerrilla group, or
insurgent organization?

Security and Background Information

Do you have a communicable disease of public health significance? (Communicable diseases of public significance NO
include chancroid, gonorrhea, granuloma inguinale, infectious leprosy, lymphogranuloma venereum, infectious
stage syphilis, active tuberculosis, and others diseases as determined by the Department of Health and Human
Services.)

Do you have a mental or physical disorder that poses or is likely to pose a threat to the safety or welfare of NO
yourself or others?

Are you or have you ever been a drug abuser or addict? NO

Have you ever been arrested or convicted for any offense or crime, even though subject of a pardon, amnesty, or NO
other similar action?

Have you ever violated, or engaged in a conspiracy to violate, any law relating to controlled substances? NO

Are you coming to the United States to engage in prostitution or unlawful commercialized vice or have you been NO
engaged in prostitution or procuring prostitutes within the past 10 years?

Have you ever been involved in, or do you seek to engage in, money laundering? NO

Have you ever committed or conspired to commit a human trafficking offense in the United States or outside the NO
United States?

Are you the spouse, son, or daughter of an individual who has committed or conspired to commit a human NO
trafficking offense in the United States or outside the United States and have you within the last five years,
knowingly benefited from the trafficking activities?

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Have you knowingly aided, abetted, assisted or colluded with an individual who has committed or conspired to NO
commit a severe human trafficking offense in the United States or outside the United States?

Do you seek to engage in espionage, sabotage, export control violations, or any other illegal activity while in the NO
United States?

Do you seek to engage in terrorist activities while in the United States or have you ever engaged in terrorist NO
activities?

Have you ever or do you intend to provide financial assistance or other support to terrorists or terrorist NO
organizations?

Are you a member or representative of a terrorist organization? NO

Are you the spouse, son, or daughter of an individual who has engaged in terrorist activity, including providing NO
financial assistance or other support to terrorists or terrorist organizations, in the last five years?

Have you ever ordered, incited, committed, assisted, or otherwise participated in genocide? NO

Have you ever committed, ordered, incited, assisted, or otherwise participated in torture? NO

Have you committed, ordered, incited, assisted, or otherwise participated in extrajudicial killings, political killings, NO
or other acts of violence?

Have you ever engaged in the recruitment or the use of the child soldiers? NO

Have you, while serving as a government official, been responsible for or directly carried out, at any time, NO
particularly severe violations of religious freedom?

Have you ever been directly involved in the establishment or enforcement of the population controls forcing a NO
woman to undergo an abortion against her free choice or a man or a woman to undergo sterilization against his or
her free will?

Have you ever been directly involved in the coercive transplantation of human organs or bodily tissue? NO

Have you ever sought to obtain or assist others to obtain a visa, entry into the United States, or any other United NO
States immigration benefit by fraud or willful misrepresentation or other unlawful means?

Have you ever been removed or deported from any country? NO

Have you ever withheld custody of a U.S. citizen child outside the United States from a person granted legal NO
custody by a U.S. court?

Have you voted in the United States in violation of any law or regulation? NO

Have you ever renounced United States citizenship for the purpose of avoiding taxation? NO

Student/Exchange Visa Information

Additional Point of Contact Information:

Name (1): GOTI, SRUSHTI SHAILESHKUMAR

Street Address: C-31 RADHESHYAM SOCIETY

WADINATH CHOK VED ROAD

City: GUJARAT

State/Province: SURAT

Postal Zone/ZIP Code: 395004

Country/Region: INDIA

Telephone Number: 07990834336

Email Address: DOES NOT APPLY

Name (2): DABHI, RITESH RAJESHBHAI

Street Address: 1ST FLOOR FLAT NO 11 PLOT NO 369

VILLAGE BHARTHAL

City: NEW DELHI

State/Province: DELHI

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Postal Zone/ZIP Code: 110077

Country/Region: INDIA

Telephone Number: 09909244974

Email Address: DOES NOT APPLY

SEVIS ID: N0034429528

Name of School: KENT STATE UNIVERSITY

Course of Study: MASTER'S IN AEROSPACE AERONATUCIAL AND

ASTRONAUTICAL

Street Address: OFFICE OF GLOBAL EDUCATION ISSS PO

BOX 5190

KENT, OHIO 44242

Location Information
Location where you will be submitting your application

Current Location: MUMBAI, INDIA

Preparer of Application
Did anyone assist you in filling out this application? NO

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You electronically signed your application on 02-Jun-2023 01:15:27 (GMT-05:00). You were required to electronically sign your
application yourself, unless otherwise exempt by regulation, even if the application was prepared by someone other than yourself.
Your electronic signature certifies that you have read and understood the questions in this application and that your answers are true
and correct to the best of your knowledge and belief. The submission of an application containing any false or misleading statements
may result in the permanent refusal of a visa or the denial of entry into the United States. All declarations made in this application
are unsworn declarations made under penalty of perjury. (28 U.S.C. 1746).

You certified that you understand that you are required to submit your visa to the United States Immigration Officer at the port
where you apply to enter the United States, and that possession of the visa does not entitle you to enter the United States if, upon
your arrival, you are found to be inadmissible under U.S. immigration laws. You certified that you understand that any willfully false
or misleading statement or willful concealment of a material fact made by you within the application may subject you to permanent
exclusion from the United States and, if you are admitted to the United States, may subject you to criminal prosecution and/or
deportation.

The information that you have provided in your application and other information submitted with your application may be accessible
to other government agencies having statutory or other lawful authority to use such information, including for law enforcement and
immigration law enforcement purposes. If fingerprints are collected as part of your application process, they may be used for the
purpose of comparing them to other fingerprints in the FBI’s Next Generation Identification (NGI) fingerprint system or its successor
systems (including civil, criminal, and latent fingerprint repositories). The photograph that you provide with your application may be
used for employment verification or other U.S. law purposes.

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