SINGLE APPLICANTS - DV LOTTERY ENTRY FORM (EBM SCHOLARS STAFF) Please enable JavaScript in your browser to complete this form. - Step 1 of 2APPLICATION 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 Information1. Name *FirstMiddleLast2. Gender *MaleFemale3. 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. Click or drag files to this area 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 *EmailConfirm Email12. What is the highest level of education you have achieved, as of today? SELECT ONE *Primary School OnlyHigh School, no degreeHigh School DegreeVocational SchoolSome University CoursesUniversity DegreeSome Graduate Level CoursesMaster's DegreeSome Doctorate Level CoursesDoctorate Degree13. What is your current marital status? *Unmarried (SINGLE)Married and my spouse is NOT a U.S. Citizen or Green Card HolderMarried and my spouse IS a U.S. Citizen or Green Card HolderDivorcedWidowedLegally Separated by the Court Order14. Number of Children (Write 0) *Number Must Be ZERO. For any person with a child or children, Fill Out FAMILY FormNextUpdating 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.PreviousSubmit
