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Below is a blank sample of the Entry Form Part One - Entrant Information.
- Name
- Last/Family Name: Type your last or family name in the field. If you don’t have one, select the No Last/Family Name check box.
- First Name: Type your first name in the field. If you don’t have one, select the No First Name check box.
- Middle Name: Type your middle name in the field. If you don’t have one, select the No Middle Name check box.
- Birth Date
- Day: Click the down arrow to open the list of numbers, and click on the correct number to populate the field.
- Month: Click the down arrow to open the list of months, and click on the correct month to populate the field.
- Year: Type in the year of birth. The principal Entrant must be at least 13 years old (born in 1998 or earlier).
- Gender: Select the circle next to either Male or Female.
- City Where You Were Born: Type the city where you were born. Do not enter the district, county, province, or state, even if that is all you know about where you were born. If you don’t know the actual city where you were born, select the Birth City Unknown check box.
- Country Where You Were Born: Click the down arrow to open the list of countries, and click on the correct country to populate the field.
- Country of Eligibility for the DV Program: The majority of Entrants are eligible to enter the DV lottery program based on the country where they were born. Were you born in a country whose natives are eligible for the DV-2013 lottery?
- Yes: You don’t have to make any changes. The Yes option is selected by default.
- No: Select the No option. Then click the down arrow to open the list of countries, and click on the correct country of eligibility to populate the field.
- Entrant Photograph: Click Browse to open the Choose file window, navigate to the location on your computer where your photograph is stored, and click Open to populate the Photograph File Name field.
- Mailing Address
- In Care Of: If someone other than yourself, such as a relative or lawyer, will be receiving mail for you, enter their name here. You may leave this field blank.
- Address Line 1: Type the first line of your address here. This field is required.
- Address Line 2: Type additional address information, such as an apartment number, here. You may leave this field blank.
- City/Town: Type the city or town of the address in this field. This field is required.
- District/County/Province/State: Enter the appropriate information for your address. This field is required.
- Postal Code/Zip Code: Type the postal or zip code here. If the address does not require this information, select the No Postal Code/Zip Code check box.
- Country: Click the down arrow to open the list of countries, and select the correct country to populate the field. This field is required.
- Country Where You Live Today: Click the down arrow to open the list of countries, and select the correct country to populate the field.
- Phone Number: You may type a phone number here where you may be contacted. This field may be left blank.
- E-Mail Address: You may type an e-mail address here by which you may be contacted. This address could be used in the future if you are selected and you respond through the ESC Web site.
- E-Mail Address: Type the e-mail address here.
- Confirm E-Mail Address: Type the same e-mail address here to confirm that it was entered correctly. You cannot copy and paste your address from the first field; you must retype it.
- What is the highest level of education you have achieved, as of today?: Select the button next to the best match for your level of education.
- What is your current marital status?: Select the button next to your marital status.
- Number of Children: If you have any biological children, legally adopted children, or stepchildren under 21 years old (born between 1990 and 2011), you must enter a number here, even if only some, or none, of them would be immigrating with you. If you have no children, you may leave this field blank.
- Click Continue. One of the following will happen: