4/1/25, 2:32 PM 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: NA, NAVJOT KAUR

Full Name in Native Language: DOES NOT APPLY

Other Names Used: NO

Telecode Name Used: NO

Sex: FEMALE

Marital Status: SINGLE

Date of Birth: 10 MARCH 2006

Place of Birth: MANDI DABWALI-, HARYANA, 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: 771229006326

U.S. Social Security Number: DOES NOT APPLY

U.S. Taxpayer ID Number: DOES NOT APPLY

Home Address: NEAR GURUDWARA SAHIB

Your Personal Copy -- Do Not Bring to Interview

https://ceac.state.gov/GenNIV/common/printapplication.aspx?P%2baJptq1Iku7EMIAzzOtTQOj9dBF9BFNVA01DbxbVto%3d 1/6
4/1/25, 2:32 PM Consular Electronic Application Center - Print Application

Your Personal Copy -- Do Not Bring to Interview

VILLAGE KAKHANWALI, PO PANJAWA

City: SRI MUKTSAR SAHIB

State/Province: PUNJAB

Postal Zone/ZIP Code: 152113

Country/Region: INDIA

Same Mailing Address? YES

Primary Phone Number: 9041987027

Secondary Phone Number: 9653800027

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): None

Social Media Identifier:

Do you have any additional social media presence? NO

Passport/Travel Document Type: REGULAR

Passport/Travel Document Number: Y4168944

Passport Book Number: DOES NOT APPLY

Country/Authority that Issued Passport/Travel Document: INDIA

City Where Issued: CHANDIGARH

State/Province Where Issued: CHANDIGARH

Country/Region Where Issued: INDIA

Issuance Date: 21 JUNE 2024

Expiration Date: 20 JUNE 2034

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? YES

Provide a complete itinerary for your travel to the U.S.:

Date of Arrival in U.S.: 15 MAY 2025

Arrival City: ARKANSAS

Date of Departure from U.S.: 19 MAY 2029

Address where you will stay in the U.S.: 2105 EAST AGGIE RD

JONESBORO

City, State, Postal/Zip Code: ARKANSAS, ARKANSAS 72401

Person/Entity Paying for Your Trip: OTHER PERSON

Person Paying for Your Trip: SINGH , GURPREET

Your Personal Copy -- Do Not Bring to Interview

https://ceac.state.gov/GenNIV/common/printapplication.aspx?P%2baJptq1Iku7EMIAzzOtTQOj9dBF9BFNVA01DbxbVto%3d 2/6
4/1/25, 2:32 PM Consular Electronic Application Center - Print Application

Your Personal Copy -- Do Not Bring to Interview

Telephone Number: 9653800027

Email Address: [email protected]

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

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.: DO NOT KNOW

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

Relationship to You: SCHOOL OFFICIAL

U.S. Contact Address: PO BOX 2230

JONESBORO AR

JONESBORO, ARKANSAS 72467

Phone Number: 8709722329

Email Address: [email protected]

Family Information
Father's Surnames: SINGH

Father's Given Names: GURPREET

Father's Date of Birth: 05 JULY 1984

Is your father in the U.S.? NO

Mother's Surnames: KAUR

Mother's Given Names: SIMRANJEET

Mother's Date of Birth: 18 MAY 1986

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

Work/Education/Training Information
Primary Occupation: NOT EMPLOYED

Explain: I HAVE COMPLETED MY SENIOR SEC

ONDARY SCHOOLING IN MAY 2024 L
AST YEAR AND THEN I APPEARED I
N THE IELTS EXAM IN AUGUST 202
4. SINCE THEN I HAVE APPLIED M
Y APPLICATION FOR THE USA STUD
Y VISA AND THUS I AM NOT EMPLO
YED.

Were you previously employed? NO

Your Personal Copy -- Do Not Bring to Interview

https://ceac.state.gov/GenNIV/common/printapplication.aspx?P%2baJptq1Iku7EMIAzzOtTQOj9dBF9BFNVA01DbxbVto%3d 3/6
4/1/25, 2:32 PM Consular Electronic Application Center - Print Application

Your Personal Copy -- Do Not Bring to Interview

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

Name of Institution (1): KK CONVENT SCHOOL

Address of Institution: VPO SINGHEWALA

DT MUKTSAR SAHIB

City: SRI MUKTSAR SAHIB

State/Province: PUNJAB

Postal Zone/ZIP Code: 152113

Country/Region: INDIA

Course of Study: 12TH SENIOR SECONDARY SCHOOLING

Date of Attendance From: 15 MARCH 2023

Date of Attendance To: 30 APRIL 2024

Name of Institution (2): KK CONVENT SCHOOL

Address of Institution: VPO SINGHEWALA

DT MUKTSAR SAHIB

City: SRI MUKTSAR SAHIB

State/Province: PUNJAB

Postal Zone/ZIP Code: 152113

Country/Region: INDIA

Course of Study: 10TH SECONDARY SCHOOL

Date of Attendance From: 15 APRIL 2021

Date of Attendance To: 30 MARCH 2022

Do you belong to a clan or tribe? NO

Provide a List of Languages You Speak:

Language Name (1): ENGLISH

Language Name (2): HINDI

Language Name (3): PUNJABI

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

Your Personal Copy -- Do Not Bring to Interview

https://ceac.state.gov/GenNIV/common/printapplication.aspx?P%2baJptq1Iku7EMIAzzOtTQOj9dBF9BFNVA01DbxbVto%3d 4/6
4/1/25, 2:32 PM Consular Electronic Application Center - Print Application

Your Personal Copy -- Do Not Bring to Interview

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?

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): SINGH, GURPREET

Street Address: VPO SINGHEWALA

DT MUKTSAR SAHIB

City: SRI MUKTSAR SAHIB

State/Province: PUNJAB

Your Personal Copy -- Do Not Bring to Interview

https://ceac.state.gov/GenNIV/common/printapplication.aspx?P%2baJptq1Iku7EMIAzzOtTQOj9dBF9BFNVA01DbxbVto%3d 5/6
4/1/25, 2:32 PM Consular Electronic Application Center - Print Application

Your Personal Copy -- Do Not Bring to Interview

Postal Zone/ZIP Code: 152113

Country/Region: INDIA

Telephone Number: 9653800027

Email Address: [email protected]

Name (2): KAUR, SIMRANJEET

Street Address: VPO SINGHEWALA

DT MUKTSAR SAHIB

City: SRI MUKTSAR SAHIB

State/Province: PUNJAB

Postal Zone/ZIP Code: 152113

Country/Region: INDIA

Telephone Number: 9041987027

Email Address: DOES NOT APPLY

SEVIS ID: N0036619527

Name of School: ARKANSAS STATE UNIVERSITY

Course of Study: PROGRAM BACHELOR OF ACCOUNTING

Street Address: 2230

JONESBORO AR

JONESBORO, ARKANSAS 72467

Location Information
Location where you will be submitting your application

Current Location: NEW DELHI, INDIA

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

Your Personal Copy -- Do Not Bring to Interview

आपने आवेदन-पत्र पर इलैक्ट्रॉनिकली हस्ताक्षर किए हैं 01-Apr-2025 03:02:33 (GMT-05:00). जब तक नियमों द्वारा छू ट नहीं हो, आपको अपने आवेदन पत्र पर
इलेक्ट्रॉनिकली हस्ताक्षर करने होंगे, आवेदन पत्र आपके अलावा किसी अन्य के द्वारा तैयार किए जाने पर भी। आपके इलेक्ट्रॉनिक हस्ताक्षर यह प्रमाणित करते हैं कि आपने इस
आवेदन-पत्र में दिए गए प्रश्नों को पढ़ और समझ लिया है, और यह कि आपकी जानकारी और विश्वास के अनुसार आपके उत्तर सत्य और सही हैं। जमा किए गए आवेदन-पत्र में
झूठे या गुमराह करने वाला ब्यौरा वीज़ा देने की हमेशा के लिए मनाही या अमेरिका में प्रवेश से मना किया जा सकता है। इस आवेदन-पत्र की सभी घोषणाएं झूठे साक्ष्य के लिए
दंड के प्रावधान के तहत बिना शपथ लिए की गई घोषणाए हैं। (28 यू.एस.सी. 1746)।

आपके आवेदन-पत्र में दी गई जानकारी और अन्य जानकारी जो आपने आवेदन-पत्र के साथ जमा की है दू सरी सरकारी एजेंसियों, कानूनी या अन्य वैधानिक अधिकारियों द्वारा
कानून प्रवर्तन और इमीग्रेशन कानून प्रवर्तन उद्देश्यों के लिए प्रयुक्त की जा सकती है। अपने आवेदन-पत्र के साथ जो फोटोग्राफ आपने दिया है वह रोजगार सत्यापन या अन्य
अमेरिकी कानूनी उद्देश्यों के लिए प्रयोग किया जा सकता

Back: Confirmation Page Print Application

https://ceac.state.gov/GenNIV/common/printapplication.aspx?P%2baJptq1Iku7EMIAzzOtTQOj9dBF9BFNVA01DbxbVto%3d 6/6