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Online Nonimmigrant Visa Application (DS-160)

Application - Sensitive But Unclassified(SBU)

We do not need a printed copy of your application at any point during your interview process. Only print this
application if you want a copy for your own records. If you print your application, please keep it secure.

Photo Provided:

Confirmation Number:

Your Personal Copy -- Do Not Bring to Interview

Personal, Address, Phone, and Passport/Travel Document Information
Name Provided: MELAKU, BETELHEM SOLOMON

Full Name in Native Language: ቤተልሔም ሰለሞን መላኩ

Other Names Used: NO

Telecode Name Used: NO

Sex: FEMALE

Marital Status: SINGLE

Date of Birth: 13 NOVEMBER 1998

Place of Birth: METHARA, OROMIA, ETHIOPIA

Country/Region of Origin (Nationality): ETHIOPIA

Do you hold or have you held any nationality other than the one NO
indicated above on nationality?

Are you a permanent resident of a country/region other than your NO

country/region of origin (nationality) above?

National Identification Number: DOES NOT APPLY

U.S. Social Security Number: DOES NOT APPLY

U.S. Taxpayer ID Number: DOES NOT APPLY

Home Address: BOLE SUB CITY

City: ADDIS ABABA

State/Province: ADDIS ABABA

Postal Zone/ZIP Code: 13674

Country/Region: ETHIOPIA

Your Personal Copy -- Do Not Bring to Interview

 Your Personal Copy -- Do Not Bring to Interview
Same Mailing Address? YES

Primary Phone Number: +251912249616

Secondary Phone Number: +251986551079

Work Phone Number: +251948010058

Do you have any additional phone numbers? NO

Email Address: solomonbetelhem521@gmail.com

Do you have any additional email addresses? NO

Do you have a social media presence?

Social Media Platform: (1): INSTAGRAM

Social Media Identifier: BEBO_TEKI

Do you have any additional social media presence? NO

Passport/Travel Document Type: REGULAR

Passport/Travel Document Number: EP6701144

Passport Book Number: 32

Country/Authority that Issued Passport/Travel Document: ETHIOPIA

City Where Issued: ADDIS ABABA

Country/Region Where Issued: ETHIOPIA

Issuance Date: 17 SEPTEMBER 2021

Expiration Date: 16 SEPTEMBER 2026

Have you ever lost a passport or had one stolen? NO

Travel Information
The List of Purposes of Trip to the U.S.

Purpose of Trip to the U.S. (1): ACADEMIC OR LANGUAGE STUDENT (F)

Specify: STUDENT (F1)

Have you made specific travel plans? YES

Provide a complete itinerary for your travel to the U.S.:

Date of Arrival in U.S.: 17 AUGUST 2023

Arrival City: NASHVILLE

Date of Departure from U.S.: 17 AUGUST 2023

Address where you will stay in the U.S.: 1101 KENNESAW DR

Person/Entity Paying for Your Trip: OTHER PERSON

Person Paying for Your Trip: BERHE , SOLOMON MELAKU

Telephone Number: +251911751830

Email Address: betelhemsolomon@yahoo.com

Relationship to You: PARENT

Is the address of the party paying for your trip the same as your Home YES
or Mailing Address?

Are there other persons traveling with you? NO

Have you ever been in the U.S.? NO

Have you ever been issued a U.S. visa? NO

Your Personal Copy -- Do Not Bring to Interview

 Your Personal Copy -- Do Not Bring to Interview
Have you ever been refused a U.S. Visa, or been refused admission to NO
the United States, or withdrawn your application for admission at the
port of entry?

Have you ever been denied travel authorization by the Department of NO

Homeland Security through the Electronic System for Travel
Authorization (ESTA)?

Has anyone ever filed an immigrant petition on your behalf with the NO
United States Citizenship and Immigration Services?

U.S. Contact Information

Contact Person Name in the U.S.: DREW, CHASITY

Organization Name in the U.S.: EAST TENNESSEE STATE UNIVERSITY

Relationship to You: SCHOOL OFFICIAL

U.S. Contact Address: B.O BOX 70,668

JOHNSON CITY, TENNESSEE 37614

Phone Number: 4234397737

Email Address: isss@etsu.edu

Family Information
Father's Surnames: BERHE

Father's Given Names: SOLOMON MELAKU

Father's Date of Birth: 17 JUNE 1976

Is your father in the U.S.? NO

Mother's Surnames: DEMESSIE

Mother's Given Names: HAYMANOT KEBEDE

Mother's Date of Birth: 29 JANUARY 1984

Is your mother in the U.S.? NO

Do you have any immediate relatives, not including parents in the U.S.? NO

Do you have any other relatives in the United States? YES

Work/Education/Training Information
Primary Occupation: AGRICULTURE

Present Employer or School Name: ROHACHEM TRADING PLC AND ETHIOPIAN

MOVEMENT FOR YOUTH & CHILDRENS RIGHT ORG

Address: LEMI KURA SUB CITY

City: ADDIS ABABA

State/Province: ADDIS ABABA

Postal Zone/Zip Code: 16360

Country/Region: ETHIOPIA

Work Phone Number: +251911143970

Monthly Salary in Local Currency (if employed): 65000

Briefly Describe your Duties: AGRONOMIST AND SALES MANAGER A

ND COUNTRY DIRECTOR

Were you previously employed? YES

Employer Name (1): DEMBI DOLLO UNIVERSITY

Employer Address: KELAM WELEGA

Your Personal Copy -- Do Not Bring to Interview

 Your Personal Copy -- Do Not Bring to Interview
City: DEMBI DOLLO

State/Province: OROMIA

Postal Zone/Zip Code: DOES NOT APPLY

Country/Region: ETHIOPIA

Telephone Number: 0575552583

Job Title: ASSISTANT LECTURER

Supervisor's Surname: TEREFE

Supervisor's Given Name: YOFETE

Employment Date From: 18 AUGUST 2021

Employment Date To: 20 APRIL 2022

Briefly describe your duties: ASSISTANT LECTURER OF

DEMBI DO
LLO UNIVERSITY

Have you attended any educational institutions at a secondary level or YES

above?

Name of Institution (1): HARAMAYA UNIVERSITY

Address of Institution: HARAMAYA

City: HARAMAYA

State/Province: HARAR

Postal Zone/ZIP Code: 138

Country/Region: ETHIOPIA

Course of Study: PLANT SCIENCE

Date of Attendance From: 28 SEPTEMBER 2017

Date of Attendance To: 24 JANUARY 2021

Do you belong to a clan or tribe? NO

Provide a List of Languages You Speak:

Language Name (1): AMHARIC AND ENGLISH

Have you traveled to any countries/regions within the last five years? YES

Provide a List of Countries/Regions Visited

Country/Region (1): UNITED ARAB EMIRATES

Country/Region (2): TURKEY

Country/Region (3): KENYA

Have you belonged to, contributed to, or worked for any professional, YES
social, or charitable organization?

Name of Organization (1): ETHIOPIAN MOVEMENT FOR YOUTH AND CHILDREN'S

RIGHT ORGANIZATION

Do you have any specialized skills or training, such as firearms, YES

explosives, nuclear, biological, or chemical experience?

Explain: HEALTH, COMPUTER TRAINING

Have you ever served in the military? NO

Have you ever served in, been a member of, or been involved with a NO
paramilitary unit, vigilante unit, rebel group, guerrilla group, or
insurgent organization?

Security and Background Information

Your Personal Copy -- Do Not Bring to Interview

 Your Personal Copy -- Do Not Bring to Interview
Do you have a communicable disease of public health significance? (Communicable diseases of public significance NO
include chancroid, gonorrhea, granuloma inguinale, infectious leprosy, lymphogranuloma venereum, infectious
stage syphilis, active tuberculosis, and others diseases as determined by the Department of Health and Human
Services.)

Do you have a mental or physical disorder that poses or is likely to pose a threat to the safety or welfare of NO
yourself or others?

Are you or have you ever been a drug abuser or addict? NO

Have you ever been arrested or convicted for any offense or crime, even though subject of a pardon, amnesty, or NO
other similar action?

Have you ever violated, or engaged in a conspiracy to violate, any law relating to controlled substances? NO

Are you coming to the United States to engage in prostitution or unlawful commercialized vice or have you been NO
engaged in prostitution or procuring prostitutes within the past 10 years?

Have you ever been involved in, or do you seek to engage in, money laundering? NO

Have you ever committed or conspired to commit a human trafficking offense in the United States or outside the NO
United States?

Are you the spouse, son, or daughter of an individual who has committed or conspired to commit a human NO
trafficking offense in the United States or outside the United States and have you within the last five years,
knowingly benefited from the trafficking activities?

Have you knowingly aided, abetted, assisted or colluded with an individual who has committed or conspired to NO
commit a severe human trafficking offense in the United States or outside the United States?

Do you seek to engage in espionage, sabotage, export control violations, or any other illegal activity while in the NO
United States?

Do you seek to engage in terrorist activities while in the United States or have you ever engaged in terrorist NO
activities?

Have you ever or do you intend to provide financial assistance or other support to terrorists or terrorist NO
organizations?

Are you a member or representative of a terrorist organization? NO

Are you the spouse, son, or daughter of an individual who has engaged in terrorist activity, including providing NO
financial assistance or other support to terrorists or terrorist organizations, in the last five years?

Have you ever ordered, incited, committed, assisted, or otherwise participated in genocide? NO

Have you ever committed, ordered, incited, assisted, or otherwise participated in torture? NO

Have you committed, ordered, incited, assisted, or otherwise participated in extrajudicial killings, political killings, NO
or other acts of violence?

Have you ever engaged in the recruitment or the use of the child soldiers? NO

Have you, while serving as a government official, been responsible for or directly carried out, at any time, NO
particularly severe violations of religious freedom?

Have you ever been directly involved in the establishment or enforcement of the population controls forcing a NO
woman to undergo an abortion against her free choice or a man or a woman to undergo sterilization against his or
her free will?

Have you ever been directly involved in the coercive transplantation of human organs or bodily tissue? NO

Have you ever sought to obtain or assist others to obtain a visa, entry into the United States, or any other United NO
States immigration benefit by fraud or willful misrepresentation or other unlawful means?

Have you ever been removed or deported from any country? NO

Have you ever withheld custody of a U.S. citizen child outside the United States from a person granted legal NO
custody by a U.S. court?

Have you voted in the United States in violation of any law or regulation? NO

Have you ever renounced United States citizenship for the purpose of avoiding taxation? NO

Student/Exchange Visa Information

Additional Point of Contact Information:

Your Personal Copy -- Do Not Bring to Interview

 Your Personal Copy -- Do Not Bring to Interview
Name (1): BISETEGN, SOLOMON WEDAJE

Street Address: GULELE SUB CITY WOREDA 03

HOUSE NO 220

City: ADDIS ABABA

State/Province: ADDIS ABABA

Postal Zone/ZIP Code: DOES NOT APPLY

Country/Region: ETHIOPIA

Telephone Number: +251911143970

Email Address: solomonwedaje@gmail.com

Name (2): TSEGAW, DAGNACHEW MELKNEW

Street Address: BOLE SUB CITY WOREDA 03

HOUSE NO 361

City: ADDIS ABABA

State/Province: ADDIS ABABA

Postal Zone/ZIP Code: DOES NOT APPLY

Country/Region: ETHIOPIA

Telephone Number: +251912393549

Email Address: wmelknew@gmail.com

SEVIS ID: N0034740841

Name of School: EAST TENNESSEE STATE UNIVERSITY

Course of Study: BIOLOGICAL SCIENCES

Street Address: P.O.BOX 70,668

JOHNSON CITY, TENNESSEE 37614

Location Information
Location where you will be submitting your application

Current Location: ADDIS ABABA, ETHIOPIA

Preparer of Application
Did anyone assist you in filling out this application? NO

Your Personal Copy -- Do Not Bring to Interview

You electronically signed your application on 23-Jul-2023 01:02:26 (GMT-05:00). You were required to electronically sign your
application yourself, unless otherwise exempt by regulation, even if the application was prepared by someone other than yourself.
Your electronic signature certifies that you have read and understood the questions in this application and that your answers are true
and correct to the best of your knowledge and belief. The submission of an application containing any false or misleading statements
may result in the permanent refusal of a visa or the denial of entry into the United States. All declarations made in this application
are unsworn declarations made under penalty of perjury. (28 U.S.C. 1746).

You certified that you understand that you are required to submit your visa to the United States Immigration Officer at the port
where you apply to enter the United States, and that possession of the visa does not entitle you to enter the United States if, upon
your arrival, you are found to be inadmissible under U.S. immigration laws. You certified that you understand that any willfully false
or misleading statement or willful concealment of a material fact made by you within the application may subject you to permanent
exclusion from the United States and, if you are admitted to the United States, may subject you to criminal prosecution and/or
deportation.

The information that you have provided in your application and other information submitted with your application may be accessible
to other government agencies having statutory or other lawful authority to use such information, including for law enforcement and
immigration law enforcement purposes. If fingerprints are collected as part of your application process, they may be used for the
purpose of comparing them to other fingerprints in the FBI’s Next Generation Identification (NGI) fingerprint system or its successor
systems (including civil, criminal, and latent fingerprint repositories). The photograph that you provide with your application may be
used for employment verification or other U.S. law purposes.