Do NOT use the browser Back and Forward Buttons when filling the application form.

Use the NEXT and PREV buttons on the bottom of this form instead.

Place your cursor over each form label for more information.

 

 

Page 1 of 4

DV 2019 Green Card Lottery Application

Personal Information
Please enter your full name as seen on your passport.
Please specify a valid last name.
Please specify a valid first name.
Please specify a valid middle name.
Please specify your gender.
Please specify your birth date.
Please specify your city/town of birth.
Please specify your country of birth.
Check this page for more information about choosing your country of eligibility.
Please select your country of eligibility.
Please upload a valid photo (file less than 2MB with the following extensions: jpg, jpeg, png, gif, tiff)
Mailing Address
Invalid Input
Please specify your street address.
Invalid Input
Please specify your city/town address.
NOTE: We are not assisting California residents with the Diversity Visa Green Card Lottery Registration.
Please specify your District/Country/Province/State address.
Please specify your Postal/ZIP code.
Please specify your country address.
Please specify in which country you live today.
Please specify a valid phone number.
Please specify a valid email address.
The email address that you enter did not match.
You have to specify the highest degree of education you finished.
We're sorry but you are not eligible to apply for a Diversity Visa.
We're sorry but you are not eligible to apply for a Diversity Visa.
Please specify your marital status.
You can double your chances by submitting a second application with your spouse as the main applicant, and you as the spouse.
Please specify how many children you have.
Personal information of your spouse
Please specify your spouse's last name
Please specify your spouse's first name.
Please specify your spouse's middle name.
The email address you entered is not valid.
Please specify the birth date of your spouse.
Please select the gender of your spouse.
Please specify your spouse's the city or town of birth.
Please specify your spouse's country of birth.
Please specify the degree of education finished by your spouse.
Please upload a valid photo (file less than 2MB with the following extensions: jpg, jpeg, png, gif, tiff)
Please specify the country of birth of your father‐in‐law.
Please specify the country of birth of your mother‐in‐law.
Personal information of your 1st living unmarried child born after 3rd October 1995
Please specify the last name of your child.
Please specify the first name of your child.
Please specify a valid middle name.
Please specify the birth date of your child.
Please specify the gender of your first child.
Please specify the city of birth of your child.
Please specify the country of birth of your child.
Please upload a valid photo (file less than 2MB with the following extensions: jpg, jpeg, png, gif, tiff)
Personal information of your 2nd living unmarried child born after 3rd October 1995
Please specify the last name of your child.
Please specify the first name of your child.
Please specify a valid middle name.
Please specify the birth date of your child.
Please specify the gender of your child.
Please specify the city of birth of your child.
Please specify the country of birth of your child.
Please upload a valid photo (file less than 2MB with the following extensions: jpg, jpeg, png, gif, tiff)
Personal information of your 3rd living unmarried child born after 3rd October 1995
Please specify the last name of your child.
Please specify the first name of your child.
Please specify a valid middle name.
Please specify the birth date of your child.
Please specify the gender of your child.
Please specify the city of birth of your child.
Please specify the country of birth of your child.
Please upload a valid photo (file less than 2MB with the following extensions: jpg, jpeg, png, gif, tiff)
Personal information of your 4th living unmarried child born after 3rd October 1995
Please specify the last name of your child.
Please specify the first name of your child.
Please specify a valid middle name.
Please specify the birth date of your child.
Please specify the gender of your child.
Please specify the city of birth of your child.
Please specify the country of birth of your child.
Please upload a valid photo (file less than 2MB with the following extensions: jpg, jpeg, png, gif, tiff)
Personal information of your 5th living unmarried child born after 3rd October 1995
Please specify the last name of your child.
Please specify the first name of your child.
Please specify a valid middle name.
Please specify the birth date of your child.
Please specify the gender of your child.
Please specify the city of birth of your child.
Please specify the country of birth of your child.
Please upload a valid photo (file less than 2MB with the following extensions: jpg, jpeg, png, gif, tiff)
Personal information of your 6th living unmarried child born after 3rd October 1995
Please specify the last name of your child.
Please specify the first name of your child.
Please specify a valid middle name.
Please specify the birth date of your child.
Please specify the gender of your child.
Please specify the city of birth of your child.
Please specify the country of birth of your child.
Please upload a valid photo (file less than 2MB with the following extensions: jpg, jpeg, png, gif, tiff)
Personal information of your 7th living unmarried child born after 3rd October 1995
Please specify the last name of your child.
Please specify the first name of your child.
Please specify a valid middle name.
Please specify the birth date of your child.
Please specify the gender of your child.
Please specify the city of birth of your child.
Please specify the country of birth of your child.
Please upload a valid photo (file less than 2MB with the following extensions: jpg, jpeg, png, gif, tiff)
Personal information of your 8th living unmarried child born after 3rd October 1995
Please specify the last name of your child.
Please specify the first name of your child.
Please specify a valid middle name.
Please specify the birth date of your child.
Please specify the gender of your child.
Please specify the city of birth of your child.
Please specify the country of birth of your child.
Please upload a valid photo (file less than 2MB with the following extensions: jpg, jpeg, png, gif, tiff)
Personal information of your 9th living unmarried child born after 3rd October 1995
Please specify the last name of your child.
Please specify the first name of your child.
Please specify a valid middle name.
Please specify the birth date of your child.
Please specify the gender of your child.
Please specify the city of birth of your child.
Please specify the country of birth of your child.
Please upload a valid photo (file less than 2MB with the following extensions: jpg, jpeg, png, gif, tiff)
Personal information of your 10th living unmarried child born after 3rd October 1995
Please specify the last name of your child.
Please specify the first name of your child.
Please specify a valid middle name.
Please specify the birth date of your child.
Please select the gender of your child.
Please specify the city of birth of your child.
Please specify the country of birth of your child.
Please upload a valid photo (file less than 2MB with the following extensions: jpg, jpeg, png, gif, tiff)
Invalid Input
Leave the following two fields below blank if you have found us on your own.
0.00 USD
Please agree with our terms and conditions.

About DVLotteryStateGov.US

DVLotteryStateGov.US is a privately-owned company that is not in any way affiliated with the United States Government.

Our customers enjoy many benefits not available to people who apply the Green Card Lottery for free on the US Government website.