by Ayaz Mahmood

Mid July, I got my acceptance from Thomas Jefferson University for an elective in Neurosurgery. It was then I decided immediately to apply for the US Visa. These days, the online application uses only a single form DS-160 that you can very easily google. Please make sure you fill it accurately and you don't make any mistakes through the application process. Double check your spellings and fill out the personal information as it appears on your passport. When filling out "US Contact information", use details of your electives coordinator. When answering where you'd stay in US, use details of your university. Don't give an impression you'd stay beyond your electives schedule or if you do, then you should have genuine reasons as you may be enquired about it. I only stated "Four weeks" in my application. This doesn't mean you won't get a Visa beyond four weeks (or 3 months as is the case).

When done, print out the confirmation page. Your photo should be taken by a good photographer. I went to Zaidi's in Lahore and he knew exactly how the photo for US or any other Visa should be like. He takes a lot more than others, but it's worth it.

A note about the DS-160: it's frustrating to fill it out because sometimes, the information simply disappears! I used the "Save" button after every page but still it just disappeared mid-way through. Since I use Google Chrome primarily for internet, it remembers every entry at every tab so filling out the form again wasn't much of an issue. Then I had to use "save application to file" after about every page. It's time consuming to fill it out but you have to be careful not to include conflicting information inside! It's a very important document that is read by your Visa Officer before the interview.

When you have your confirmation page, if you're in Lahore, you should head straight to American Express Bank. This is near Alhamra Hall and Assembly hall, right inside the heart of PIA's office. Be prepared to take about 13,000 Rupees with you as the service charges beyond the Visa fees may be variable (Visa fees is fixed). You'd get a date by next week.

Now you have to gather all your documents. This is a bit of a troublesome process and should you realize that you can't gather all of them before your visa interview date, I think you can re-schedule it. I have no idea about the process or any fees associated so you may have to head straight back to American Express bank and ask them directly about delaying it. Preferably don't schedule your interview date in the first place if you're not sure you can gather your documents. You'd get the Visa date within another week anyway so this isn't a very troublesome thing.

Here's a list of documents I took (as you can see, this is also mentioned in other visa guidance articles!):

1. Acceptance email. I couldn't get a formal acceptance letter so I decided to use the email. I thought this was very fine but if someone has a different opinion, please do write it in the comments.

2. Email exchanges with electives coordinator. I printed all emails from requesting electives application to acceptance email and medical clearance in case the Visa Officer might need further confirmation beyond the acceptance email.

3. Affidavit of non-immigrant intent. I stated I would need to come back immediately after my electives are done so that I may appear for the final examination without which my degree would not be given to me.

4. Affidavit of support. Since my father is supporting me financially, I got this signed by him and attached a copy of his National Identity Card.

5. Medical school transcripts: Take the same transcripts that you would send to any US university including a letter that mentions the graduation date. This also serves as proof that you're enrolled at your respective medical school.

6. No-objection-certificate: States no objections against a specified time period at the specified institution and gives reasons for coming back to home country.

7. Supporting person's documents: Bank statement (or recent bank deposits), Tax return forms (if available), Property letter (if available), employment letter (if available) and/or any other documents that affirm financial strength. You don't need to take just about all of these but preferably atleast two, including bank statement. Making a bank statement may or may not take substantial time so have it made prior to applying for Visa, not at the eleventh hour. If your supporting person is related by blood, these financial documents can also prove stronger ties with home country rather than US so they are very useful.

8. Birth certificate: can prove your relation to the supporting person if they're parents. Not mandatory.

9. Police Clearance: This isn't required. US embassy does its own clearance. However Canada and UK embassy may require it.

10. Itinerary: You may need to contact a travel agent and get a quote that mentions your departure and return dates and the route you follow. (All itinerary documents have that info mentioned).

11. Accommodation: You may be asked where you would be staying in US. As stated, you can simply state University campus. If you don't have a reservation already made, simply print out the accommodation details from the website.

12. Exam scores: TOEFL and USMLE Step 1. Don't be afraid to take these documents with you. You may be especially enquired about USMLEs because Visa Officers know about it very well. When your reason for US Visa is Step 2 CS, they may also ask whether or not you have given your Step 1 and 2 CK! Furthermore in my opinion, mentioning having taken Step 1 doesn't really weaken your case that you may pursue a residency. Be prepared to answer if inquired about future plans. You can simply say: I took Step 1 because an increasing number of universities require Step 1 for granting clinical electives and that I would have to come back, complete my internship/house job first, and then think about Step 2 and residency.

13. Malpractice Insurance and Health Insurance: Not really required. Just that these things may mention the dates for which they work.

14. Miscellaneous documents: Any other document that may support your case and prove you would definitely come back once your tenure in US is completed.

In Pakistan there are only two places where interviews are conducted: Islamabad and Karachi. DS-160 form asks you to select either of these locations and once done, you'd need to travel to these places. Arrange for accommodation and travel method. Although I was given a time of 8:00AM, this doesn't mean you have to absolutely report at or before this time. Preferably leave as early as possible because early hours has substantially less traffic and you would not have to face absurdly long queues. If you have a car available, you can simply park it at the diplomatic enclave and go to the embassy through the shuttle service (it charges 500 Rs for return ticket).

I went and stayed overnight at Dr. Umar's place. It was raining very hard that day and there was also a misfortune of an airplane crash killing in excess of 150 people. Later next day there was to be more damages and deaths due to floods caused by excess rainfall which probably broke all records. 

During my stay, I also had a mock interview by Dr. Umar and let's say, he's very good at taking interviews! So I had a good practice beforehand and I would suggest you also make a list of questions you may be asked. Refer to a later stage in the article for possible questions and answers, as well as other Visa guidance articles on this website.

Time passed, I went to sleep and woke at 6:15 am in the morning, quickly took a bath and wore some decent clothes. Here is an idea: Try to dress decent and smart. I didn't wear a suit or a tie and if you do, you might feel a bit overdressed during the Visa interview because you'd encounter people in all sorts of clothes. But a decent look is important and you must be clean-shaved preferably if you don't sport a beard. If you do, then trim it to give a good look. For females, it's advisable that you observe your cultural dress rather than jeans and T-shirt. I saw quite a few girls who appeared for the Visa interview wearing tight jeans and low-neck shirts which is totally unnecessary and impolite in an interview. There were also other women who were wearing head-scarves, hijab or dupatta and they were easily getting Visas.

Another note about language: Visa officers know Urdu very well and you'd be surprised at the clarity and sweetness of their Urdu compared to ours. Although as a doctor you are definitely expected to know English very well, for other circumstances, you may even select Urdu as your Visa interview language. Speak politely and clearly. Don't try to emulate an American accent; speak in your own native accent, exactly a way how an Indian or a Pakistani person is expected to speak in English. There's no shame in that. If you don't understand a question VO asks, as he or she may speak fast, don't be afraid to ask them to repeat their question. As a sidenote, there were people especially girls who were speaking loudly in such an unnatural manner it was funny. Trying to act like an American would absolutely not give you any edge; infact there's a danger it may backfire.

I left with Uncle at about 6:45 AM who was very nice through the trip and kept encouraging me for the Visa. I reached in about 40 minutes and all of a sudden it started raining hard. I didn't have an umbrella but I didn't really need it as I jumped into the waiting area immediately. I deposited my mobile phone there and purchased the shuttle ticket and jumped inside. It was still raining a lot. When I reached the embassy I was directed to the waiting room and after a while, my finger prints were taken biometrically and I was directed to the Visa interview place. I was surprised that even at about 8:00 AM there were so many people already. There were about 12 bank-counter type interview hubs of which first 8 were for immigrant Visas and last four for non-immigrant Visas. It was surprising to see how many people apply for US immigration, a lot more probably than for Visitor Visas. I sat there waiting for a long time. About two hours to be exact. Some interviews were going unusually long , with average times of about 10 minutes and as much as 30 minutes in which the interviewee was also asked to show some family pictures, and he showed virtually his whole marriage photo album and probably most other documents. There was also another interview where someone was going for a business purpose, probably to learn some new marketting techniques, and he was asked to narrate in a greatly detailed manner, where he is employed, what exactly he does and what he expects to learn in US about marketting. It was very detailed and he kept speaking for atleast 10-12 minutes on that one question only. He was probably given the Visa as he was very confident and informed about his purpose and what he hoped to achieve, and the fact he was perfectly happy and satisfied by his job in Pakistan. There were atleast two cases, where there was a couple wanting to go to US to visit the husband's brother, and another woman wanting to go to support her father who had some cardiac condition. She was granted the Visa and when she passed infront of me, I noticed a distinct smile on her face, which was slightly objectionable in my opinion as she tried to sound genuinely concerned infront of the VO about her father's condition. There were also some other students who wanted an F-Visa type. My purpose to tell you all of this is that you should be prepared to answer also in detail where and why you want to go to US and what you hope to achieve. Additionally you should have strong reasons to come straight back to Pakistan. Your college transcripts are a strong reason.

Finally my turn came and I went for the interview. Here's how it went:

VO: Why do you want to go US?

Me: I wish to attend a four-clinical clerkship at Thomas Jefferson University.

VO: So what would you be doing there?

Me: Clerkship in Neurosurgery.

VO: Tell me a bit more about it.

Me: I would be attending the wards with the physicians, preparing and presenting cases in conferences, and learn new surgical techniques.

VO: So you're a physician?

Me: No I am a medical student at KEMU.

VO: Who would be supporting you?

Me: My father

VO: How long do you intend to stay?

Me: Only four weeks

VO: Do you have any relatives in US?

Me: Only distant ones.

Then he typed something onto his computer for about 2 minutes, picked up a letter, stamped it and told me this:

VO: I have provisionally approved your Visa. It would have to undergo administrative clearance now. It may take some time but hopefully it shouldn't be more than 2 weeks. There's very little chance that your Visa may be rejected on clearance so hopefully everything's should be fine. Here's a letter that explains what would be happening.

Me: When can I expect to pick my passport?

VO: After clearance, you would receive a call from American Express asking you to pick your passport.

Me: Thankyou very much!

VO: You're welcome!

That's it! He didn't ask for any document which was a bit of a surprise but because I had four neatly arranged files with all important documents, this must have had an impact that I had brought all important evidence of where I'd be going, for what purpose, for what duration and the fact I would be coming back as soon as the purpose of trip is over. I had realized I didn't ask him for the duration of Visa!

Six days later, I received a call from American Express. I went and opened my passport to see they had stamped a five-year multiple B1/B2 Visa type.

That day, it was still raining hard. Infact about half a foot worth of water came inside the embassy waiting room. So there's 150mm rain right inside the US embassy! The guard had placed some plastic tables and all of us whose interviews were done, hopped onto the tables and made our way out to find the shuttle waiting. Thankfully rain had temporarily stopped but as soon as I jumped into the bus, it started again. By the time I reached the enclave parking, rain stopped again and I made my way into a taxi who charged me a lot. I bargained with him for about 10 minutes when I finally reached my destination but my mistake was, that I didn't settle the charges before picking it up. Eventually I payed him some extra so that I can finally jump out of that broken taxi car. I decided to stay another night at Umar's place.

There had to be some way in order to celebrate with my greatest friend of all times. Thankfully I had my Sony Playstation Portable so we both decided to share the gameplay. Eventually I also downloaded chess and tic-tac-toe in my mobile and both resulted in embarrassing wipeouts for Umar bhai, not to mention he BARELY won 3-1 with Arsenal in FIFA 10 against the lowest ranked opposition at the easiest difficulty level (debutant). I just wondered, how much he might have suffered if he actually matched against me instead of Artificial intelligence of computer, in FIFA 10? Well, then there was also some talk about Step 1 and electives and then the whole time just passed like that till next morning, when I finally left for home. Interestingly, it AGAIN started raining when I was boarding the bus and it looked like rain had a special agenda against me all that time around. I left the rain behind me, and finally reached Lahore where I challenged rain to come again. And it didn't. Funny enough, 4 days later it DID and totally rocked me on my motorbike on my way home from college. I lose. Rain win. Never mock the heavens.

So there it is, all my experience was about for the US Visa. Next to follow is the type of questions you may be asked.

Questions you should be prepared to answer (with answers pertaining to my particular case)

1. Why did you choose Thomas Jefferson?

A. My course instructor, Dr. Robert Rossenwasser - the chief of Neurosurgery, is an expert in vascular neurosurgery and interventional neuroradiology both of which are subjects I wish to specialize and research into at a later stage in my career.

2. Why did you choose US?

A. US training in surgical specialties is very highly recognized and appreciated in Pakistan and I would like to transfer skills I acquire in US to help modernize healthcare in Pakistan.

3. Where do you intend to stay in US?

A. At my university campus (I intended to show a print-out from Thomas Jefferson showing campus residence details at this stage).

4. Why don't you stay at your relatives' place?

A. I do not know them well enough to request accommodation at their place. (NOTE: Relative status acquires much more importance when they're close. By close, as mentioned on DS-160 form, it means either parents, siblings or children. If you have any of these in US, I think it's advisable that you do mention it on DS-160 and also to the VO. This may go against your Visa case but it's better to stay honest and clear. If anyone else has a different opinion regarding this matter, please mention below in comments so that others may get an idea on it).

5. Would you come back to Pakistan?

A. (Final exams, internships etc provide a good reason).

6. Have you done Step 1?

A. Yes. (There's no harm in mentioning that)

7. So you intend to pursue a residency?

A. Yes. But for the moment, I have to attend to exams/housejob/interships in Pakistan before I can finalize my plans to complete my USMLE examinations and apply for residency. (Again there's no harm in mentioning what you intend to do in future. But be careful not to sound overly ambitious about your plans. Stay clear and to the point and especially highlight the fact you have important business to attend in Pakistan or India).

8. Why are you attending a clerkship in neurosurgery? Are there no clerkships available in Pakistan?

A. There is generally a lack of good training in neurosurgery in Pakistan because it is a very highly specialized field that requires intensive time commitment and financial investment to establish in a hospital. Because US Hospitals are so well equipped with new technology, it would be profitable to learn and train in US and help strengthen this field in Pakistan. Because US Hospitals constantly update their management protocols with new knowledge and research, it would be helpful to transfer the knowledge and skills acquired in US to Pakistani hospitals so that the patients suffering from neurosurgical diseases can benefit.

9. Where is Thomas Jefferson?

A. Philadelphia, State of Pennsylvania.

10. Tell me a bit more about the location.

A. Center City, Philadelphia. Walnut Street.

11. Do you plan to visit your relatives?

A. No, I don't know them well enough. (You can modify your answers accordingly. There's no harm in mentioning you might visit your relatives but just be careful that you answer every following question carefully and stress upon the fact you would definitely come back to your home country).

12. Do you wish to settle permanently in US?

A. At the moment I am only planning to complete my clerkship and come back for (exams/housejob/internships/degree).

13. What do your parents do?

A. (Mention about employment - preferably show an employment letter here too. You may be asked to show bank statement here too so be ready).

14. What do your siblings do?

A. (Give details of their education/employment and location)

15. What are electives?

A. A short period of clinical training in a US hospital.

16. You're a student so why are you applying for a B1/B2 visa?

A. (Here show a print-out from university mentioning all visiting foreign students need to attend on a B1 visa type).

Any more question you would have liked to be discussed here, please include in the comments and I'd add here.

Some more tips and tricks with myths:

Be totally confident. You're a doctor and you're supposed to remain confident, and speak in a polite and decent manner. If for instance you are not granted the Visa, arguing with the VO would not change the outcome. Simply walk out and re-apply and there's a high chance you would get the Visa the next time. Your case to visit US is a genuine one for the sake of working/learning in a US Hospital and the only way your Visa would be rejected is either when you're plain unlucky, or you commit a blunder. A statement that mentions you have plans to stay in US is a blunder. A statement that mentions you are not sure when you would come back to your home country after completion of electives is another blunder.

If your visa is or has been rejected in the past, this never means you can't get Visa with another try. As you can read in other guidance articles and comments on this website, there are few who have been rejected Visa for Step 2 CS, only to be given on a second application for Visa. I have a friend who was rejected on first try for electives, but he got the Visa on second attempt. By all means re-apply and preferably using the same acceptance letter. If date for electives has passed, you can simply apply on basis of another acceptance mentioning that your time for electives has passed, or delay your electives to a later date.

What you must NOT do infront of VO is brag about anything. Don't brag about your profession, don't brag about your USMLE scores, don't brag about where you got the electives. The VO knows very well about various hospitals and institutions. After all, they're all based in HIS home country! Such bragging may become a reason for repetitive rejections. Stay calm, polite and gentle in your interview. Stay to the point and answer exactly what has been asked. Preferably show your documents only when the VO wishes to have a look at them. If you are going for electives at Mayo Clinic for example, the VO knows very well that it's the premiere institution and hospital in US that has no parallel. There is absolutely no need to mention how good it is!

Your documents must be neatly arranged and tabbed for easily retrieval. The VO would definitely give you time to take out your documents but it's better if you can just take it out quickly and show.

Don't actually ask for a 5 year or a 10 year multiple Visa! Just mention your duration of stay in US and that's all. You may ask how much duration has been granted. It depends what VO and embassy decide should be the duration of your Visa and whether it's multiple entry or single entry. If you get only a 3 month Visa and perhaps need more to go for another elective at a later date, definitely apply again and this time because you had already gone to US and come back as well, your case again becomes a very strong one to be granted Visa again.

As I mentioned already, be dressed well. Although it actually doesn't matter if you go wearing jeans, but by all means dress like a doctor would. Your dress and hairstyle should be neat in your Visa Photo as well. All these things do have a positive impact, making a statement of how well organized a person you are.

Good luck in the pursuit of your ambitions and career!

Regards

Ayaz