Carlamae Alveen Pelaez

Have you used additional email address in the last five years? Yes, please indicated the email address:

Person/Entity paying for your trip:

Mother’s Middle before married:

Status of your sister in the U.S?:

Work Phone Number:

Brief Describe your duties as project manager:

Were you previously employed:

Date of attendance from (specific month):

Date of attendance to (specific month):

Carla Pelaez
Are you a permanent resident of a country/region other than your country/region of origin (nationality)
above? YES : indicate what nationality:

Email address: purpplectravelservices@ymail.com – please confirm this email (YMAIL OR GMAIL)

Have you used additional email addresses in the last five years ? YES, please indicate the email address:

Person/Entity paying for your trip:

Previous U.S travel information

Date arrived: 1996 (specific month):

Date arrived: 1998 (specific months):

Date arrived: 2002 (specific month):

Date arrived: 2006 (specific month:

Date last visa was issued:

Visa number 8 digits:

Is your father in the U.S: YES if deceased its a NO. because he already dead.

Middle name of father: D ??

Mother’s full name (before married):

Mother’s Given name: Dolor or Dolores please confirm

Have you attended any educational institutions at secondary level above? Please confirm if you attend
college or highschool (highest education) and answer the question below:

Name of institution:

Address:

State/Province:

Country Region:

Course of study:

Date of attendance from:

Date of attendance to:

Celso Pelaez
Person/entity paying for your trip:

Father’s middle name: O ??

Mother’s middle name before married:

Have you attended any educational institutions at secondary level above? Please confirm if you attend
college or highschool (highest education) and answer the question below:

Name of institution:

Address:

State/Province:

Country Region:

Course of study:

Date of attendance from:

Date of attendance to: