Date of birth *

Country Of Birth *

Phone *

Email *

Organization

Address

City

State

Postal code

Country

Do you have an official academic record showing that you have a degree, diploma, certificate, or similar award from a college, university, school, or other institution of learning relating to your area of exceptional ability or national importance?

Yes

Do you have any licenses or certificates that are relevant for your work?

How many years of provable professional work experience do you have?

Only count experience with employers who you believe will agree to provide an Employment Verification Letter that proves the dates of employment and job title.

Summarize your top contributions/achievements in your profession.

Are you a member of any professional associations? Please list all (if any)

Have you received any awards for your professional work? Please explain.

Have you authored books, scholarly articles, instruction manuals, blog posts, videos? Please describe and provide links or attach copies below.

Has a company or employer used anything that you created? E.g. a new manufacturing method, an algorithm, a new business model?

Have you invented anything? Do you have any patents in your name or are you listed on any patent applications?

Has your work or research received funding from the federal government?

Yes

Has your work or research helped your team/your advisor/your department in obtaining funding?

Yes

E.g. has anything you worked on been mentioned on a grant application that your superior or advisor submitted to obtain funding for a project? If you don't know, ask your superiors.

If granted a green card, what would you like to do in the United States professionally?

Be an entrepreneura

Work for someone else

Something else

Have you or has your work been in the news? Include links to any news articles, interviews, media coverage.

Explain how you think your future work is important for your field/industry? What are the potential results or outcomes of allowing you to do this work in the US?

Attach any other documents you think are relevant, e.g. photos, articles of your work, your inventions (must be in one single file).

is there anything else you think we should know about you that might help explain how you are exceptional at your job or how the US would benefit from giving you a green card?

Attach Your CV

Provide URL to your LinkedIn profile (if you have one)

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