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Online Nonimmigrant Visa Application (DS-160)

Application - Sensitive But Unclassified(SBU)

We do not need a printed copy of your application at any point during your interview process. Only print this
application if you want a copy for your own records. If you print your application, please keep it secure.

Photo Provided:

Confirmation Number:

Your Personal Copy -- Do Not Bring to Interview

Personal, Address, Phone, and Passport/Travel Document Information
Name Provided: TRAN, HOANG THIEN KIM

Full Name in Native Language: TRAN HOANG THIEN KIM

Other Names Used: NO

Telecode Name Used: NO

Sex: FEMALE

Marital Status: SINGLE

Date of Birth: 09 FEBRUARY 2006

Place of Birth: HO CHI MINH, VIETNAM

Country/Region of Origin (Nationality): VIETNAM

Do you hold or have you held any nationality other than the one NO
indicated above on nationality?

Are you a permanent resident of a country/region other than your NO

country/region of origin (nationality) above?

National Identification Number: 079306014728

U.S. Social Security Number: DOES NOT APPLY

U.S. Taxpayer ID Number: DOES NOT APPLY

Home Address: 163 DASH 14 DASH 19 TO HIEN THANH

City: HO CHI MINH

State/Province: DOES NOT APPLY

Postal Zone/ZIP Code: DOES NOT APPLY

Country/Region: VIETNAM

Your Personal Copy -- Do Not Bring to Interview

Your Personal Copy -- Do Not Bring to Interview
Same Mailing Address? YES

Primary Phone Number: 0934786309

Secondary Phone Number: DOES NOT APPLY

Work Phone Number: DOES NOT APPLY

Do you have any additional phone numbers? NO

Email Address: [email protected]

Do you have any additional email addresses? NO

Do you have a social media presence?

Social Media Platform: (1): None

Social Media Identifier:

Do you have any additional social media presence? NO

Passport/Travel Document Type: REGULAR

Passport/Travel Document Number: E00465385

Passport Book Number: DOES NOT APPLY

Country/Authority that Issued Passport/Travel Document: VIETNAM

City Where Issued: HO CHI MINH

Country/Region Where Issued: VIETNAM

Issuance Date: 12 JULY 2023

Expiration Date: 12 JULY 2033

Have you ever lost a passport or had one stolen? NO

Travel Information
The List of Purposes of Trip to the U.S.

Purpose of Trip to the U.S. (1): ACADEMIC OR LANGUAGE STUDENT (F)

Specify: STUDENT (F1)

Have you made specific travel plans? YES

Provide a complete itinerary for your travel to the U.S.:

Date of Arrival in U.S.: 15 DECEMBER 2024

Arrival City: SEATTLE

Date of Departure from U.S.: 25 AUGUST 2025

Address where you will stay in the U.S.: 1216 S 273RD PL

Person/Entity Paying for Your Trip: OTHER PERSON

Person Paying for Your Trip: TRUONG , MY HANH

Telephone Number: 84903858161

Email Address: [email protected]

Relationship to You: PARENT

Is the address of the party paying for your trip the same as your Home YES
or Mailing Address?

Are there other persons traveling with you? YES

Are you traveling as part of a group or organization? NO

Persons Traveling with You:

Your Personal Copy -- Do Not Bring to Interview

Your Personal Copy -- Do Not Bring to Interview
Name (1): TRUONG, MY HANH

Relationship to You: PARENT

Have you ever been in the U.S.? YES

Date Arrived (1): 30 JUNE 2024

Length of Stay: 28 DAY(S)

Do you or did you hold a U.S. Driver's License? NO

Have you ever been issued a U.S. Visa? YES

Date Last Visa was Issued: 13 MAY 2024

Visa Number: 202412493000

Are you applying for the same type of visa? NO

Are you applying in the same country where the visa above is issued YES
and is this country your principal country of residence?

Have you been ten-printed? NO

Has your U.S. Visa ever been lost or stolen? NO

Has your U.S. Visa ever been cancelled or revoked? NO

Have you ever been refused a U.S. Visa, or been refused admission to NO
the United States, or withdrawn your application for admission at the
port of entry?

Has anyone ever filed an immigrant petition on your behalf with the NO
United States Citizenship and Immigration Services?

U.S. Contact Information

Contact Person Name in the U.S.: TRUONG, THI PHUONG DUNG

Organization Name in the U.S.: KENSINGTON GLOBAL LLC

Relationship to You: RELATIVE

U.S. Contact Address: 1216 S 273RD PL

DES MOINES, WASHINGTON 98198

Phone Number: 2068250988

Email Address: [email protected]

Family Information
Father's Surnames: TRAN

Father's Given Names: LE NGHIA

Father's Date of Birth: 20 AUGUST 1971

Is your father in the U.S.? NO

Mother's Surnames: TRUONG

Mother's Given Names: MY HANH

Mother's Date of Birth: 11 JULY 1974

Is your mother in the U.S.? NO

Do you have any immediate relatives, not including parents in the U.S.? NO

Do you have any other relatives in the United States? YES

Work/Education/Training Information
Primary Occupation: STUDENT

Present Employer or School Name: TRUNG VUONG HIGH SCHOOL

Your Personal Copy -- Do Not Bring to Interview

Your Personal Copy -- Do Not Bring to Interview
Address: 3A NGUYEN BINH KHIEM, DIST. 1

City: HO CHI MINH

State/Province: DOES NOT APPLY

Postal Zone/Zip Code: DOES NOT APPLY

Country/Region: VIETNAM

Work Phone Number: 02838297706

Monthly Salary in Local Currency (if employed): DOES NOT APPLY

Briefly Describe your Duties: STUDYING THERE FROM 9TH GRADE

TO 12TH GRADE.

Were you previously employed? NO

Have you attended any educational institutions at a secondary level or NO

above?

Do you belong to a clan or tribe? NO

Provide a List of Languages You Speak:

Language Name (1): VIETNAM - ENGLISH

Have you traveled to any countries/regions within the last five years? YES

Provide a List of Countries/Regions Visited

Country/Region (1): UNITED STATES OF AMERICA

Country/Region (2): SINGAPORE

Country/Region (3): MALAYSIA

Have you belonged to, contributed to, or worked for any professional, NO
social, or charitable organization?

Do you have any specialized skills or training, such as firearms, NO

explosives, nuclear, biological, or chemical experience?

Have you ever served in the military? NO

Have you ever served in, been a member of, or been involved with a NO
paramilitary unit, vigilante unit, rebel group, guerrilla group, or
insurgent organization?

Security and Background Information

Do you have a communicable disease of public health significance? (Communicable diseases of public significance NO
include chancroid, gonorrhea, granuloma inguinale, infectious leprosy, lymphogranuloma venereum, infectious
stage syphilis, active tuberculosis, and others diseases as determined by the Department of Health and Human
Services.)

Do you have a mental or physical disorder that poses or is likely to pose a threat to the safety or welfare of NO
yourself or others?

Are you or have you ever been a drug abuser or addict? NO

Have you ever been arrested or convicted for any offense or crime, even though subject of a pardon, amnesty, or NO
other similar action?

Have you ever violated, or engaged in a conspiracy to violate, any law relating to controlled substances? NO

Are you coming to the United States to engage in prostitution or unlawful commercialized vice or have you been NO
engaged in prostitution or procuring prostitutes within the past 10 years?

Have you ever been involved in, or do you seek to engage in, money laundering? NO

Have you ever committed or conspired to commit a human trafficking offense in the United States or outside the NO
United States?

Are you the spouse, son, or daughter of an individual who has committed or conspired to commit a human NO
trafficking offense in the United States or outside the United States and have you within the last five years,
knowingly benefited from the trafficking activities?

Your Personal Copy -- Do Not Bring to Interview

Your Personal Copy -- Do Not Bring to Interview
Have you knowingly aided, abetted, assisted or colluded with an individual who has committed or conspired to NO
commit a severe human trafficking offense in the United States or outside the United States?

Do you seek to engage in espionage, sabotage, export control violations, or any other illegal activity while in the NO
United States?

Do you seek to engage in terrorist activities while in the United States or have you ever engaged in terrorist NO
activities?

Have you ever or do you intend to provide financial assistance or other support to terrorists or terrorist NO
organizations?

Are you a member or representative of a terrorist organization? NO

Are you the spouse, son, or daughter of an individual who has engaged in terrorist activity, including providing NO
financial assistance or other support to terrorists or terrorist organizations, in the last five years?

Have you ever ordered, incited, committed, assisted, or otherwise participated in genocide? NO

Have you ever committed, ordered, incited, assisted, or otherwise participated in torture? NO

Have you committed, ordered, incited, assisted, or otherwise participated in extrajudicial killings, political killings, NO
or other acts of violence?

Have you ever engaged in the recruitment or the use of the child soldiers? NO

Have you, while serving as a government official, been responsible for or directly carried out, at any time, NO
particularly severe violations of religious freedom?

Have you ever been directly involved in the establishment or enforcement of the population controls forcing a NO
woman to undergo an abortion against her free choice or a man or a woman to undergo sterilization against his or
her free will?

Have you ever been directly involved in the coercive transplantation of human organs or bodily tissue? NO

Have you ever been the subject of a removal or deportation hearing? NO

Have you ever sought to obtain or assist others to obtain a visa, entry into the United States, or any other United NO
States immigration benefit by fraud or willful misrepresentation or other unlawful means?

Have you failed to attend a hearing on removability or inadmissibility within the last five years? NO

Have you ever been unlawfully present, overstayed the amount of time granted by an immigration official or NO
otherwise violated the terms of a U.S. visa?

Have you ever been removed or deported from any country? NO

Have you ever withheld custody of a U.S. citizen child outside the United States from a person granted legal NO
custody by a U.S. court?

Have you voted in the United States in violation of any law or regulation? NO

Have you ever renounced United States citizenship for the purpose of avoiding taxation? NO

Have you attended a public elementary school on student (F) status or a public secondary school after November NO
30, 1996 without reimbursing the school?

Student/Exchange Visa Information

Additional Point of Contact Information:

Name (1): LE, THI NGOC MINH

Street Address: 711 DASH 39 HUNG PHU, WARD 10, DIST. 8

City: HO CHI MINH

State/Province: DOES NOT APPLY

Postal Zone/ZIP Code: DOES NOT APPLY

Country/Region: VIETNAM

Telephone Number: 0902756366

Email Address: [email protected]

Name (2): NGUYEN, VINH PHUONG MINH

Your Personal Copy -- Do Not Bring to Interview

Your Personal Copy -- Do Not Bring to Interview
Street Address: 1216 S 273RD PL

City: DES MOINES

State/Province: WA

Postal Zone/ZIP Code: 98198

Country/Region: UNITED STATES OF AMERICA

Telephone Number: 2066931306

Email Address: [email protected]

SEVIS ID: N0036124540

Name of School: GREEN RIVER COLLEGE

Course of Study: ART STUDIES

Street Address: 12401 SE 320TH ST.

AUBURN, WASHINGTON 98092

Location Information
Location where you will be submitting your application

Current Location: HO CHI MINH CITY, VIETNAM

Preparer of Application
Did anyone assist you in filling out this application? NO

Your Personal Copy -- Do Not Bring to Interview

You electronically signed your application on 05-Sep-2024 02:57:49 (GMT-05:00). You were required to electronically sign your
application yourself, unless otherwise exempt by regulation, even if the application was prepared by someone other than yourself.
Your electronic signature certifies that you have read and understood the questions in this application and that your answers are true
and correct to the best of your knowledge and belief. The submission of an application containing any false or misleading statements
may result in the permanent refusal of a visa or the denial of entry into the United States. All declarations made in this application
are unsworn declarations made under penalty of perjury. (28 U.S.C. 1746).

You certified that you understand that you are required to submit your visa to the United States Immigration Officer at the port
where you apply to enter the United States, and that possession of the visa does not entitle you to enter the United States if, upon
your arrival, you are found to be inadmissible under U.S. immigration laws. You certified that you understand that any willfully false
or misleading statement or willful concealment of a material fact made by you within the application may subject you to permanent
exclusion from the United States and, if you are admitted to the United States, may subject you to criminal prosecution and/or
deportation.

The information that you have provided in your application and other information submitted with your application may be accessible
to other government agencies having statutory or other lawful authority to use such information, including for law enforcement and
immigration law enforcement purposes. If fingerprints are collected as part of your application process, they may be used for the
purpose of comparing them to other fingerprints in the FBI’s Next Generation Identification (NGI) fingerprint system or its successor
systems (including civil, criminal, and latent fingerprint repositories). The photograph that you provide with your application may be
used for employment verification or other U.S. law purposes.

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