DV 2027 SINGLE APPLICATIONS

Welcome to the EBM SCHOLARS Diversity Visa Program Application Support System

Once our staff completes the form, please carefully review all the information to ensure it is accurate and all spellings are correct. The details provided here will be used to complete your official Diversity Visa (DV) Lottery application

Please enable JavaScript in your browser to complete this form.

- Step 1 of 2

APPLICATION NUMBER *

MPESA PAYMENT CONFIRMATION CODE *

NAME OF STAFF FILLING OUT THE FORM *

PLEASE MAKE SURE CUSTOMER REVIEWS AND APPROVES THE INFORMATION FILLED BEFORE SUBMISSION

Part One - Entrant Information

1. Name *

First

Middle

Last

2. Gender *Choice 3MaleFemale

3. Date of Birth (Month, Date, Year) Write month in words, example February 10, 1999 *

4. City Where You Were Born *

5. Country You Were Born *

6. Country of Eligibility (Write country you were born, unless you were born in a country not eligible) *

7. Entrant Photograph (Upload all photos you need me to use. Each photo indicate the name of the person, if you have a a family). EBM SCHOLARS Team will edit for you to put in proper measurements.

Drag & Drop Files, Choose Files to Upload You can upload up to 20 files.

9. City Where You Live Today *

9. Country Where You Live Today *

10. WhatsApp Phone Number *

11. E-Mail Address *

Email

Confirm Email

12. What is the highest level of education you have achieved, as of today? SELECT ONE *

• Primary School Only
• High School, no degree
• High School Degree
• Vocational School
• Some University Courses
• University Degree
• Some Graduate Level Courses
• Master's Degree
• Some Doctorate Level Courses
• Doctorate Degree

13. What is your current marital status? *

• Unmarried (SINGLE)
• Married and my spouse is NOT a U.S. Citizen or Green Card Holder
• Married and my spouse IS a U.S. Citizen or Green Card Holder
• Divorced
• Widowed
• Legally Separated by the Court Order

14. Number of Children (Write 0) *

Number Must Be ZERO. For any person with a child or children, Fill Out FAMILY Form

Next

Updating preview…

This is a preview of your submission. It has not been submitted yet!
Please take a moment to verify your information. You can also go back to make changes.

Previous

Submit