Micronesia Embassy

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Please help us to better serve you by registering with the Embassy. Your information will be restricted solely for the use of the FSM Embassy here in Washington, DC and will not be distributed to any other party. Please note that the more information you provide, the better we can assist you and/or your family when necessary. Thank you.

Last Name:
Middle or Maiden Name:
First Name:
Male or Female:
Street Address:
City:
State:
Zip Code:
Telephone:
Cell Phone:
Fax number:
Email Address:
Second Email Address:
Date of Birth:
FSM Passport Number:
Date of Issuance:
Date of Expiration:
Please specify your state of origin:
Date of first arrival in US:
Port of entry into the US:
Purpose here in the US: (i.e. school, nursing program, military, marriage to US spouse, other work) Please specify:
Employer Name:
Employer Address: (please break it out, city, state, etc.)
Employer Telephone Number:
Employer Fax Number:
Employer Email Address:
I have a current EAD Card:
My “A” number from my EAD card is:
I have a US SS Number:
I have a copy of my I94 card in safekeeping in case it is lost or damaged:
My passport is expired:
I am a homeowner:
Do you live with your family or with other FSMers?
How many other FSMers live with you: (include children)
In case of emergency, please contact my family in Micronesia at the following address.
Street Address:
City:
State or Island:
Zip:
Full Name:
Telephone Number:
Employer:
In case of emergency, please contact my family in the US at the following address.
Full Name:
Street Address:
City:
State or Island:
Zip:
Telephone Number:

1725 ‘N’ Street, NW Washington, DC 20036 | Tel: (202) 223-4383 | Fax: (202) 223-4391 | Email: firstsecretary@fsmembassydc.org
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