Sentri Application Form PDF Details

The SENTRI (Secure Electronic Network for Travelers Rapid Inspection) application form, managed by the U.S. Department of Homeland Security and U.S. Customs and Border Protection, outlines a comprehensive process for travelers seeking expedited entry into the United States from Mexico. This form collects detailed personal information, including name, gender, date of birth, citizenship, and residence details, alongside proof of citizenship or residency. Applicants are required to provide an extensive five-year history of their addresses and employment, underscoring the program's thorough background check aimed at enhancing border security. Additionally, the form accommodates different types of applicants including those applying for the first time either with or without a vehicle, those seeking renewal, and those in need of card or vehicle decal replacement. Vehicle registration data is also collected for applicants who wish to use their vehicle in the SENTRI lanes, subject to age restrictions. The form is designed to facilitate the assessment of eligibility for the SENTRI program, which offers expedited border crossing for pre-approved, low-risk travelers. It includes provisions for fee payment and a certification section where the applicant must attest to the truthfulness and completeness of the information provided, acknowledging the potential for information sharing among various law enforcement and government agencies in both the U.S. and Mexico. This rigorous application process underscores the balance between facilitating efficient border crossings for trusted travelers and ensuring the security and integrity of U.S. borders.

QuestionAnswer
Form NameSentri Application Form
Form Length4 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min
Other namesform sentri application, sentri application, application section sentri, customs protection sentri

Form Preview Example

DEPARTMENT OF HOMELAND SECURITY

U.S. Customs and Border Protection

SENTRI Application

Approved OMB No. 1651-0121 Exp. 8-31-2014

1. Applicant's age is 14 years or younger (check box)

1a. (Check one box only)

 

First time applicant without vehicle

 

 

Applicant renewal

 

Card replacement

1b. SENTRI ID

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

First time applicant with vehicle

 

Add vehicle

 

 

Vehicle decal replacement

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION A - PERSONAL INFORMATION

2. Last/Paternal Name

2a. Maternal name

3. First name

4. Middle name (in full)

4a. Suffix

5. Other names used (e.g., maiden name, former name)

 

 

 

 

Nickname

 

 

 

6. Gender

 

 

 

 

 

7. Date of Birth (yyyy/mm/dd)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Male

 

 

Female

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8.

 

 

 

City

 

 

 

 

 

 

 

 

 

 

 

 

Country

 

 

 

 

 

 

 

 

 

 

 

 

 

 

State

 

 

 

 

 

 

 

 

 

Place of birth

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9. Citizenship (Check all that apply.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

10. Residence

 

 

 

 

 

 

 

 

 

 

 

 

Canadian citizen

 

 

 

 

 

 

U.S. citizen

 

 

Mexican citizen

 

 

 

Other (Must Specify)

 

 

 

 

 

 

 

 

 

 

 

 

Canada

 

 

 

 

United States

 

Mexico

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11. Proof of citizenship/residency/immigration status (Attach copies)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

U.S. Alien Registration No.

 

or

 

Border Crossing Card No.

 

 

 

 

 

 

 

 

 

 

Birth Certificate No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Passport No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Country of Issuance

 

 

 

 

 

 

 

 

 

 

 

(Expiration Date)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(yyyy/mm/dd)

 

 

 

 

Other Type of Document

 

 

 

 

 

 

 

 

 

 

No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Expiration Date)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(yyyy/mm/dd)

 

 

 

 

Drivers license No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Attach Copy)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

State and Country of Issuance

 

 

 

 

 

 

 

 

 

(Expiration Date)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(yyyy/mm/dd)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION B - ADDRESS HISTORY FOR THE LAST 5 YEARS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

12. Current address

(yyyy/mm)

13. Street Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Apt. No.

14. City

 

 

 

 

 

 

 

 

15. Colonia/Neighborhood

 

 

 

As of what

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

date?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

16. Country

 

 

 

 

17. State

 

 

 

 

18. Postal/Zip Code

 

19. Home telephone

 

20. Business telephone/Cell phone number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ext.

 

 

 

Mailing address if different from residential address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

21. Street Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Apt. No.

 

22. City

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

23. Colonia/Neighborhood

24. Country

25. State

26. Postal/Zip Code

Previous residential addresses if current residence is less than five years (address history continued on page 4).

27.

(yyyy/mm)

(yyyy/mm)

28. Street Address

 

Apt. No.

29. City

 

From:

To:

 

 

 

 

 

 

 

 

 

 

 

 

 

30. Colonia/Neighborhood

 

31. Country

32. State

 

33. Postal/Zip Code

 

 

 

 

 

 

 

 

 

34.

(yyyy/mm)

(yyyy/mm)

35. Street Address

 

Apt. No.

36. City

 

From:

To:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

37. Colonia/Neighborhood

38. Country

39. State

40. Postal/Zip Code

41.(yyyy/mm)

From:

(yyyy/mm) 42. Street Address

To:

Apt. No.

43. City

44. Colonia/Neighborhood

45. Country

46. State

47. Postal/Zip Code

Paperwork Reduction Act Statement: An agency may not conduct or sponsor an information collection and a person is not required to respond to this information unless it displays a current valid OMB control number and an expiration date. The control number for this collection is 1651-0121. The estimated average time to complete this application is 40 minutes. If you have any comments regarding the burden estimate you can write to U.S. Customs and Border Protection, Office of Regulations and Rulings, 799 9th Street, NW., Washington DC 20229.

CBP Form 823S (10/10)

SECTION C - EMPLOYMENT HISTORY FOR THE LAST 5 YEARS (if applicable)

48.

Current employer

(yyyy/mm)

(yyyy/mm)

49. Employer's name

 

 

 

 

 

 

 

 

From:

 

 

 

To:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

50.

Street Address

 

 

 

 

 

 

Apt. No.

51. City

 

52. Colonia/Neighborhood

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

53. Country

 

 

 

 

 

54. State

 

55. Postal/Zip Code

 

56. Telephone number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ext.

57. Occupation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Previous Employer name and address if current employer is less than five years (employment history continued on page 4).

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

58.

(yyyy/mm)

 

(yyyy/mm)

59. Employer's name

 

 

 

 

60. Street Address

 

Apt. No.

 

From:

 

 

To:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

61. City

62. Colonia/Neighborhood

63. Country

64. State

65. Postal/Zip Code

SECTION D - ADDITIONAL INFORMATION

66.

Have you ever been convicted of an offense in any country?

What country were you convicted in?

Have you ever received a waiver of inadmissibility to the U.S. from CBP (former USINS)?

Have you ever been found in violation of customs or immigration laws?

If you have answered YES, please give details:

N o

No

No

Yes

Yes

Yes

SECTION E – UNITED STATES CONTACT INFORMATION

Note: If U.S. contact information is not completed, Customs and Border Protection (CBP) will attempt to contact applicant via telephone for U.S. contact information. Application will not be accepted, if no U.S. contact information is available.

67.Full Name

68.Street Address

69. U.S. City

U.S. State

Postal/Zip Code

SECTION F – VEHICLE DATA

Note: An applicant does not have to provide vehicle data to enroll in SENTRI (i.e. carpool). However, if an applicant wishes to utilize their vehicle in the SENTRI lane, he or she must provide the vehicle data. Vehicle can only be registered for those persons age 18 and over.

70.

Make

 

 

 

 

71.

Model

 

 

 

 

72.

Year

 

 

 

 

73.

Color

 

 

 

 

74.

VIN No.

 

 

 

 

75.

License Plate No.

 

 

 

 

76.

Country

77. State

 

 

 

 

Registered Owner Information

78.Last/Paternal Name

79.First name

78a. Maternal name

79a. Middle name (in full)

79b. Suffix

 

 

80.Gender Male

Female

81. Date of Birth (yyyy/mm/dd)

CBP Form 823S (10/10)

Sentri Application Form isn’t the one you’re looking for?

Related Documents