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Applicant Information
First Name *
Please enter your first name.
Last Name *
Please enter your last name.
Middle Name
Suffix
Date of Birth *
Please enter your date of birth.
City of Birth *
Please enter your city of birth.
Country of Birth *
Please select your country of birth.
State/Territory of Birth *
Please select your state/territory of birth.
Social Security Number *
?
Please enter a valid SSN in the format XXX-XX-XXXX.
Sex *
Select...
Male
Female
Other
Please select your sex.
Height *
Feet
Inches
Please select your height.
Hair Color *
Select...
Black
Brown
Blonde
Red
Gray
Bald
Other
Please select your hair color.
Eye Color *
Select...
Blue
Brown
Green
Hazel
Gray
Amber
Other
Please select your eye color.
Occupation *
?
Please enter your occupation.
Employer or School
Contact Information
Mailing Address Line 1 *
Please enter your mailing address.
Address Line 2
City *
Please enter your city.
Country *
Please select your country.
State *
Please select your state.
Zip Code
If the applicant is a child, enter the name of a parent or guardian who receives mail at the address *
Please enter the guardian's name.
Is This Your Permanent Address? *
Yes
No
Permanent Address
Mailing Address Line 1 *
Please enter your permanent address.
Address Line 2
City *
Please enter your permanent city.
Country *
Please select your permanent country.
State *
Please select your permanent state.
Zip Code
Preferred Method of Communication *
Select...
Mail
Email
Both
Please select a method of communication.
Your Email Address *
Please enter a valid email address.
Confirm Email Address *
Email addresses must match.
Your Phone Number *
Please enter your phone number.
Phone Type *
Select...
Home
Work
Cell
Please select a phone type.
Travel Plans
Date of Your Trip
Date of Return
Countries to be Visited
Emergency Contact
First and Last Name
Relationship to Applicant
Street Address/RFD# or PO Box
Apt/Suite#
City
State
Zip Code
Telephone Number
Your Most Recent Passport
Have you been issued any of the following? *
Passport book
Passport card
Both
Never had a passport before
Do you still have the book in your possession? *
Yes
Yes – it was damaged or mutilated
No – it was lost
No – it has been stolen
Have you reported your lost or stolen book/card? *
Yes
No
The Date Your Most Recent Passport Book Was Issued (MM/DD/YYYY) *
Please select the issue date.
Your Name as Printed on Your Most Recent Book
First and Middle Name
Please enter your first and middle name as printed.
Last Name
Please enter your last name as printed.
Book Number *
Please enter the book number.
Was the data printed correctly in your most recent document? *
No, it was printed incorrectly on my passport book
No, it was printed incorrectly on my passport book and card
No, it was printed incorrectly on my passport card
Yes, it was printed correctly
Please select the item(s) that are printed incorrectly:
Last Name
Middle Name
Date of Birth
First Name
Place of Birth
Sex
Has your name changed since your most recent document was issued? *
Yes, it has changed since I got my passport book
Yes, it has changed since I got my passport card
No, it has not changed since I was issued a document
Reason for the Name Change *
Select...
Marriage
Court Order
Please select a reason for the name change.
Place of Name Change (City/State) *
Please enter the place of name change.
Date of Name Change *
Please enter the date of name change.
Can you submit certified documentation to reflect the name change? *
Yes
No
Please indicate if you can provide documentation.
List All Other Names You Have Used
What Would You Like to Renew? *
Passport book
Passport card
Passport book & card
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