1. Do you have any current or past diagnosis of a communicable disease of public health significance?
No, I do not have any current or past diagnosis of a communicable disease of public health significance.
2. Have you ever been diagnosed with or had treatment for tuberculosis?
No, I have not.
3. Have you ever been diagnosed with, treated for, or had a positive test result for syphilis?
No, I have never been diagnosed with, treated for, or had a positive test result for syphilis.
4. Are you currently under medical treatment, or have you been under medical treatment within the past two years for a physical or mental disorder?
No.
5. Do you have any physical or mental disorder that could interfere with your ability to care for yourself or perform any gainful activity?
No, I do not have any physical or mental disorder that could interfere with my ability to care for myself or perform any gainful activity.
6. Do you have a history of drug abuse or addiction?
No, I do not.
7. Have you ever been arrested, detained, or convicted of any crime or offense and/or been in any institution for the alleged commission of a crime or offense?
No.
8. Have you ever used illegal drugs?
No.
9. Are you a member or affiliated with any organization, association, society, movement, group, or combination of persons that advocates the overthrow of the United States government by force or violence?
No, I am not.
10. Have you ever engaged in conduct that would indicate a danger to the safety or welfare of others?
No, I have not.
11. Have you ever ordered, incited, assisted, or otherwise participated in the persecution of any person because of race, religion, nationality, political opinion, social group, or because that person is a member of a particular social group?
No, I have not.
12. Have you ever engaged in terrorist activity?
No, I have not.
13. Have you ever engaged in any other activities that would indicate a danger to the safety or welfare of the United States?
No, I have not.
14. Are you inadmissible to the United States based on health-related grounds as specified in 8 U.S.C 1182(a)(1)?
No, I am not inadmissible to the United States based on health-related grounds as specified in 8 U.S.C 1182(a)(1).
15. Are you inadmissible to the United States based on criminal activity as specified in 8 U.S.C 1182(a)(2)?
The answer to this question depends on the individual’s specific circumstances. If the individual has been convicted of a crime that is considered inadmissible under 8 U.S.C 1182(a)(2), then they would be inadmissible to the United States.
16. Are you inadmissible to the United States based on security reasons as specified in 8 U.S.C 1182(a)(3)?
No, unless there is evidence to suggest that you are inadmissible, the question cannot be answered definitively.
17. Are you inadmissible to the United States based on public charge as specified in 8 U.S.C 1182(a)(4)?
No, not unless you meet the criteria for inadmissibility as listed in 8 U.S.C 1182(a)(4).
18. Are you inadmissible to the United States based on fraud/misrepresentation as specified in 8 U.S.C 1182(a)(6)?
No, unless a specific instance of fraud or misrepresentation has been identified by the United States Department of Homeland Security or another government agency.
19. Are you inadmissible to the United States based on unlawful presence as specified in 8 U.S.C 1182(a)(7)?
No, not unless you have stayed in the United States beyond the authorized period of admission without obtaining the appropriate permission.
20. Are you inadmissible to the United States due to any other ground not mentioned above as specified in 8 U.S.C 1182(a)?
No, I am not inadmissible to the United States due to any other ground not mentioned above.