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U.S. Department of State
Bureau of Consular Affairs
Electronic Diversity Visa
Applicant Entry System: 12.4
Electronic Diversity Visa Entry Form
OMB Control Number: 1405-0153
Form: DS-5501
Expires: 08/31/2019
Estimated Burden: 30 minutes
If you need to go back and make a correction, do NOT use the back button on your browser.
Instead use the appropriate button here or below:
Part One - Entrant Information
1. Name
a. Last/Family Name
NGUENA KAMDOUM
b. First Name
ESTHER MARTINE
c. Middle Name
KENFACK
2. Gender
Female
3. Birth Date
April 28, 2001
4. City Where You Were Born
BAFANG
5. Country Where You Were Born
Cameroon
6. Country of Eligibility for the DV Program
Cameroon
7. Entrant Photograph
(Photograph received)
8. Mailing Address
a. In Care Of (optional)
b. Address Line 1
9127 DAVENE LANE
c. Address Line 2 (optional)
d. City/Town
LAUREL
e. District/County/Province/State
MD
f. Postal Code/Zip Code
20723
g. Country
United States Of America
9. Country Where You Live Today
Cameroon
10. Phone Number
237 653 38 33 02
11. E-mail Address
[email protected]
(NOTE: This e-mail address will be used to provide you with additional information if you are selected.)
12. What is the highest level of education you have achieved, as of today?
Some University Courses
You must have a minimum of a high school diploma reflecting the completion of a full course of
study (vocation schools or equivalency degrees are not acceptable) or be a skilled worker in an
occupation that requires at least two years of training or experience to qualify (visit
http://www.onetonline.org/ to see if your occupation qualifies) for a Diversity Visa.
13. What is your current marital status?
Unmarried
Legal separation is an arrangement when a couple remain married but live apart, following a
court order. If you and your spouse are legally separated, your spouse will not be able to
immigrate with you through the Diversity Visa program. You will not be penalized if you choose
to enter the name of a spouse from whom you are legally separated.
If you are not legally separated by a court order, you must include your spouse even if you plan
to be divorced before you apply for the Diversity Visa. Failure to list your eligible spouse is
grounds for disqualification.
If your spouse is a U.S. citizen or Lawful Permanent Resident, do not list him/her in your entry.
14. Number of Children
0
Children include all biological children, legally adopted children, and stepchildren who are
unmarried and under the age of 21 on the date you submit your entry. You must include all
eligible children, even if they do not live with you or if they do not intend to apply for a
Diversity Visa as your derivative. Failure to list all eligible children is grounds for
disqualification. If your child is a U.S. citizen or Lawful Permanent Resident, do not list him/her
in your entry.
Please print this page for your personal records. You will need to use your browser's print button
for this.
PAPERWORK REDUCTION ACT: Public reporting burden for this collection of information
is estimated to average 30 minutes per response, including time required for searching existing
data sources, gathering the necessary documentation, providing the information and/or
documents required, and reviewing the final collection. You do not have to supply this
information unless this collection displays a currently valid OMB control number. If you have
comments on the accuracy of this burden estimate and/or recommendations for reducing it,
please send them to: [email protected].
CONFIDENTIALITY STATEMENT: The information asked for on this form is requested
pursuant to Section 222 of the Immigration and Nationality Act. INA Section 222(f) provides
that visa issuance and refusal records shall be considered confidential and shall be used only for
the formulation, amendment, administration, or enforcement of the immigration, nationality, and
other laws of the United States. Certified copies of visa records may be made available to a court
which certifies that the information contained in such records is needed in a case pending before
the court.
This site is managed by the Bureau of Consular Affairs, U.S. Department of State. External links to other Internet
sites should not be construed as an endorsement of the views contained therein.
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U.S. Department of State
Bureau of Consular Affairs
Electronic Diversity Visa
Applicant Entry System: 12.4
DV-2020 Submission Confirmation: Entry Received
Success!
Your entry for the 2020 Diversity Visa Lottery program was received on Wednesday, October
31, 2018 at 5:30:40 PM EDT. Please do NOT close this window until you have printed this
confirmation page or made a record of your Confirmation Number.
Entrant Name:
NGUENA KAMDOUM, ESTHER MARTINE KENFACK
Confirmation Number:
2020298MSSUNUMQ8
Year of Birth:
2001
Digital Signature:
35E9E80D8F346CC0F6E56ED0B016FE8F7A683C75
Thank you for your entry for the 2020 Diversity Visa Lottery.
Please either print this page or make a record of the confirmation number before closing
this window. You will not be able to retrieve this number after you close this window.
You must retain your confirmation number in order to check your entry status via Entrant
Status Check between May 7, 2019 and September 30, 2020 to determine whether your entry
was selected for further processing in the 2020 Diversity Visa Lottery. You will be REQUIRED
to enter your confirmation number in combination with other personal information in order to
check on your entry status.
Selectees will not receive selectee notifications or letters by regular postal mail from the
Kentucky Consular Center (KCC).
Do not submit additional Entry Forms with this person as the Primary Entrant! Multiple
entries will disqualify the Entrant from participation in the 2020 Diversity Visa Lottery.
This site is managed by the Bureau of Consular Affairs, U.S. Department of State. External links to other Internet
sites should not be construed as an endorsement of the views contained therein.
