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Travel Information

Intended date of travel*

Intended length of stay*

(days)

Please enter a number from 1 to 365.

Please give detail to why you are applying to travel from the UK to the United States*

IF you are not normally a resident in the UK, please provide the reasons why you are travelling to the US from the UK

Why do you believe your travel is time-sensitive?*

Why do you believe your travel is in the US national interest?*

Are you the spouse of a US citizen or LPR?*

Yes
No

Are you the child of a US citizen or LPR?*

Yes
No

Are you under the age of 21 and unmarried?*

Yes
No

Are you the parent of a US citizen or LPR?

Yes
No

Is your child under the age of 21 and unmarried?*

Yes
No

Are you the sibling of a US citizen or LPR?*

Yes
No

Is your sibling under the age of 21 and unmarried?*

Yes
No

Do you wish to visit an individual in the US?*

Yes
No

Individual's full name*

Individual's citizenship*

Individual's email address*

Individual's telephone number*

Individual's address*

Street Address Address Line 2 City State ZIP Code

Does your reason for travel involve the death of a family member?*

(If so, you will be expected to provide a death certificate and proof of relation)

Yes
No

Is the reason for your travel in relation to an illness or other medical issue?

(yours or someone else's)

Yes
No

Are you a healthcare working wishing to travel for Coronavirus-related employment reasons?*

Yes
No

Do you wish to travel for employment or business reasons?*

Yes
No

Do you intend to self-isolate for 14 days upon arrival to the US and adhere to the CDC's Guidelines for Travellers Returning from International Travel?*

This includes: conducting a temperature check twice a day, staying inside and avoiding contact with others, not taking public transport and maintaining social distance from others.

Yes
No

Have you exhibited any COVID-19 symptoms?*

Yes
No

Have you been tested/screened for COVID-19?*

Yes
No

Are you travelling with anyone else?*

Yes
No

Who are you travelling with?*

Family/Friend
Colleague

Their Name*

First Last

Their date of birth*

Their country of birth*

Their nationality*

Their visa or ESTA number*

Relationship to you*

Their job title*

Please give detail of your plan to adhere to the CDC (Centre for Disease Control and Prevention) guidelines concerning COVID-19?*

Please note: holding a National Interest Exemption does not make one exempt from the government's and state's department for health's COVID-19 regulations.

All travellers must observe the US government's regulations.

National Interest Exemption

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