Form DS-3053, Statement of Consent Instructions
This form contains 21 fields organized into 6 sections. Below is a complete list of every field, its type, and what information is expected.
| Field Name | Type | Description |
|---|---|---|
| Applying Adult Information | ||
| 2a Applying Adult Name | Text |
Enter the full legal name of the adult applying on behalf of the child.
|
| 2a Applying Adult Relationship_Legal#20Parent | CheckBox |
Check this box if the applying adult is a legal parent of the child.
|
| 2a Applying Adult Relationship_Legal#20Guardian | CheckBox |
Check this box if the applying adult is a legal guardian of the child.
|
| 2a Applying Adult Relationship_Third#20Party | CheckBox |
Check this box if the applying adult is a third party, not a legal parent or guardian.
|
| Child Information | ||
| Check box if age 16 or 17 | CheckBox |
Check this box if the child is aged 16 or 17.
|
| 1a Child’s Name | Text |
Enter the full legal name of the child applying for the passport.
|
| 1b Child's Birthdate | Date |
Enter the birthdate of the child in MM/DD/YYYY format.
|
| Form Controls | ||
| Reset | Button |
This button resets the form, clearing all entered data. Use this if you need to start over with filling out the form.
|
| Non-Applying Parent/Guardian Information | ||
| Non-applying legal parent 1 | Text |
Enter the name of the non-applying legal parent or guardian.
|
| Non-applying legal parent 2 | Text |
Enter the name of the second non-applying legal parent or guardian, if applicable.
|
| NALP Check box if same as 1 | CheckBox |
Check this box if the non-applying legal parent's address is the same as the child's.
|
| NALP Street Address 1 | Text |
Enter the street address of the non-applying legal parent or guardian.
|
| NALP Street Address 2 | Text |
Enter additional street address information for the non-applying legal parent or guardian, if needed.
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| NALP Street Address City StateCountry Zip Code 1 | Text |
Enter the city, state, country, and zip code for the non-applying legal parent's address.
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| NALP Street Address City StateCountry Zip Code 2 | Text |
Enter additional city, state, country, and zip code information for the non-applying legal parent's address, if needed.
|
| NALP Phone 1 | Text |
Enter the primary phone number for the non-applying legal parent or guardian.
|
| NALP Phone 2 | Text |
Enter an additional phone number for the non-applying legal parent or guardian, if applicable.
|
| NALP Email 1 | Text |
Enter the primary email address for the non-applying legal parent or guardian.
|
| NALP Email 2 | Text |
Enter an additional email address for the non-applying legal parent or guardian, if applicable.
|
| Oath/Affirmation | ||
| SECTION 4. OATH/AFFIRMATION. STOP HERE! Do not sign this form until requested to do so by a notary | CheckBox |
This checkbox is part of the oath or affirmation section. Do not check this box until you are in the presence of a notary or passport authorizing officer who requests you to do so.
|
| Passport Preferences | ||
| Issue passport book only” or “Issue passport card only | Text |
Specify whether to issue a passport book only or a passport card only.
|