1、U.S. Department of StateSUPPLEMENTAL NONIMMIGRANT VISA APPLICATIONPLEAST TYPE OR PRINT YOUR ANSWERS IN THE SPACE PROVIDED BELOW EACH ITEM PLEASE ATTACH AN ADDITIONAL SHEET IF YOU NEED MORE SPACE TO CONTINUE YOUR ANSWERS1. Last Name(s) (List all Spellings)Lu2. First Name(s) (List all Spellings)Wei3.
2、Full Name (in Native Alphabet) (请填中文全名 )卢巍4. Clan or Tribe Name (If Applicable)N/A5. Spouses Full Name (If Married)N/A5. 配偶全名( 如已婚 )无6. Fathers Full NameLu Hua6. 父亲全名卢华7. Mothers Full NameWang Mei7. 母亲全名王梅8. Full Name and Address of Contact Person or Organization in the United States (Include Teleph
3、one Number)San Francisco State UniversityAdd: 8 Buidling, Lus Street, San Francisco, CA, 95544, USA. TEL:919-876-0889. List All Countries You have Entered in the Last Ten Years(Give the Year of Each Visit)USA, UK, JAPAN10. List All Countries That Have Ever Issued You a PassportChina11. Have You Ever
4、 Lost a Passport or Had One Stolen? Yes No12. Not Including Current Employer, List Your Last Two EmployersName N/AAddress Telephone No. Job Title Supervisors Name Dates of Employment 12. 列出上两任雇主（除现任雇主外）公司名称: 无公司地址: 电话号码: 工作职务: 主管姓名: 起止日期: Name N/AAddress Telephone No. Job Title Supervisors Name Date
5、s of Employment 公司名称: 无公司地址: 电话号码: 工作职务: 主管姓名: 起止日期: 13. List all Professional, Social and Charitable Organizations to Which You Belong (Belonged) or Contribute (Contributed) or with Which You Work (Have Worked)N/A14. Do You Have Any Specialized Skills or Training, Including Firearms, Explosives, Nu
6、clear, Biological, or Chemical Experience?Yes No If YES, please explain15. Have You Ever Performed Military Service? Yes No If Yes, Give Name of Country, Branch of Service, Rank / Position, Military Specialty and Dates of Service16. Have You Ever Been in an Armed Conflict, Either as a Participant or
7、 Victim? Yes No If YES, please explain.17. List All Educational Institutions You Attend or Have Attended.Include Vocational Institutions But Not Elementary Schools.Name of Institution Jilin Institute of Technology Address/Telephone No. Changchun City, 86-431-1111111 Course of Study Bachelor of Engli
8、sh Dates of Attendance 9/199917. 列出所有你曾经和目前就读的学校, 包括职校, 但不包括小学。学校名称: 吉林工学院地址/电话: 中国吉林省长春市人民大街 86-431-11111111 所学课程: 英语学士 起止日期: 09/1999Name of Institution Baishan No. 2 High School Address/Telephone No. Baishan City, 86-439-32222222 Course of Study Senior high school Dates of Attendance 09/1996学校名称:
9、白山市第二中学地址/电话: 中国吉林省白山市 86-439-32222222 所学课程: 高中 起止日期: 09/199618. Have You Made Specific Travel Arrangements? Yes No If YES, please provide a complete itinerary for your travel, including arrival/departure dates, flight information, specific location you will visit, and a point of contact at each loc
10、ation.Paperwork Reduction Act Statement*Public reporting burden for this collection of information is estimated to average 1 hour per response, including time required for searching existing data sources, gathering the necessary data, providing the information required, and reviewing the final colle
11、ction. You do not have to provide the information unless this collection displays a currently valid OMB number. Send comments on the accuracy of this estimate of the burden and recommendations for reducing it to: U.S. Department of State, A/RPS/DIR, Washington, DC 20520.DS-15704-2006Approved OMB 1405-0134Expires 09/30/2008Estimated Burden 1 hour
