Validated September 2025 I-693 Immigration Exam

Your Full Legal Name (Do not provide a nickname)

Given Name (First Name)Middle Name (if applicable)Family Name (Last Name)

In Care Of Name (if any)

Street Number and Name

ApartmentSuite NameFloor

Apartment, Suite , or Floor Number [if any]

City or Town

State

ZIP Code

Province

Postal Code

Country

Gender

MaleFemale

Date of Birth (mm/dd/yyyy)

Date

City/Town/Village of Birth

Country of Birth

Alien Registration Number (A-Number if any, Type Number Only)

USCIS Online Account Number (if any)

Are you eligible for the vaccination record portion only and have already completed an overseas immigration exam?

I am eligible for completion of the vaccination record portion only, because I previously completed an overseas immigration medical examination, signed by a panel physician (refugee or derivative asylee adjustment of status applicants under Immigration and Nationality Act (INA) section 209 and K nonimmigrant visa holders applying for adjustment of status.

Applicant's Daytime Telephone Number

Format: (000) 000-0000.

Applicant's Mobile Telephone Number (if any)

Format: (000) 000-0000.

Applicant's Email Address (if any)

example@example.com

Interpreter's Email Address (if any)

example@example.com

Person Preparing this Application, if Other Than the Applicant

Preparer's Given Name (First Name)Preparer's Family Name (Last Name)

Preparer's Daytime Telephone Number

Format: (000) 000-0000.

Preparer's Mobile Telephone Number (if any)

Format: (000) 000-0000.

Preparer's Email Address (if any)

example@example.com