APPLICATION FOR A U.S. PASSPORT
Select document(s) for which you are submitting fees:
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U.S. Passport Book
U.S. Passport Card
Both
The U.S. Passport Card is not valid for intermational air travel. See instructon Page 3.
Regular Book (Standard)
Large Book (Non-Standard)
The large book is for frequent international travelers who need more visa pages.
1. Last Name
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First Name
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Middle Name
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2. Date of Birth
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3. Sex
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M
F
4. Place of Birth (City & State if in the U.S. or City & Country as it is presently known.)
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5. Social Security Number
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6. USCIS Registration A-Number (if applicable)
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7. Email
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See application status at passportstatus.state.gov
8. Mailing Address Line 1: Street/RFD#, P.O. Box, or URB. Also include Apartment, Suite, etc.
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Address Line 2: (If applicant is a child, write "In Care Of” the parent) Example: In Care Of - Jane Doe.
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City
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State
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Zip Code
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Country (If outside the United States)
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Enter your country
9. Primary Contact Phone Number
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List all other names you have used. (Examples: Birth Name, Maiden, Previous Marriage, Legal Name Change). If needed, attach additional pages.
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Name of Applicant (Last, First, & Middle)
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Date of Birth
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10. Parental Information
Mother/Father/Parent - First & Middle Name (at Parent's Birth)
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Last Name (at Parent's Birth)
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Date of Birth
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Place of Birth (City & State if in the U.S. or City & Country as it is presently known.)
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Sex
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M
F
U.S. Citizen?
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Yes
No
Mother/Father/Parent - First & Middle Name (at Parent's Birth)
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Last Name (at Parent's Birth)
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Date Of Birth
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Place of Birth (City & State if in the U.S. or City & Country as it is presently known.)
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Sex
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M
F
U.S. Citizen?
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Yes
No
11. Have you ever been married?
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Yes
No
If yes, complete the remaining items in #11.
Full Name of Current Spouse or Most Recent Spouse (Last, First & Middle)
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Date of Birth
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Place of Birth
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U.S. Citizen?
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Yes
No
Date of Marriage
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Have you ever been widowed or divorced?
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Yes
No
Widow/Divorce Date
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12. Additional Contact Phone Number
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Home
Work
Cell
13. Occupation (if age 16 or older)
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14. Employer or School (if applicable)
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15. Height
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16. Hair Color
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17. Eye Color
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18. Travel Plans (If not travel plans, please write "none")
Departure Date
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Return Date
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Countries to be Visited
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19. Permanent Address (Complete if P.O. Box is listed in Mailing address
or
if residence is different from Mailing address. Do not list a PO Box.)
Street/RFD # or URB
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Apartment/Unit
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City
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State
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ZIP Code
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20. Your Emergency Contact (Provide the information of a person not traveling with you to be contacted in the event of an emergency.)
Name
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Address: Street/RFD # or URB
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Apartment/Unit
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City
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State
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ZIP Code
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Phone Number
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Relationship
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21. Have you ever applied for or been issued a U.S. Passport Book or Passport Card?
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Yes
No
If yes, complete the remaining items in #21.
Name printed on your most recent book
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Status of Book
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Submitting with application
Stolen
Lost
In my possession (if expired)
Name printed on your most recent card
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Status of Card
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Submitting with application
Stolen
Lost
In my possession (if expired)
If your most recent passport book/card was lost or stolen, you must explain in detail below. Please provide your previous book/card number and include the date and location (address/city/state/country) of the loss/theft, if known. Please indicate whether you filed a police report, and if it is available, please submit a copy. If you need more space, continue on a separate sheet of paper.
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