Passport Appointment Request

Applicant Name(s)

Applicant Name(s)
	Applicant Name(s) First Name Last Name	Item weight

more items

Parent Name (for Minor Applicants only)

Phone Number

Number of Adults (Ages 18+) Applying for Passport

Number of Minors (Ages 16-17) Applying for Passport

Number of Minors (Ages 15 and below) Applying for Passport

Have any applicants had a passport book previously? If yes, when was the passport book issued?

IF a Minor (Ages 15 and below) is Applying- Will BOTH/ALL Parents be Present?

Yes

No, but we will bring the notarized DS-3505 form and a color copy of the absent parent's ID

My situation is different and I need further assistance

Other…

Will the Passport Application need to be expedited? (additional $60 fee)

Yes

Unsure

Do you have the following documents?

DS-11 Form (NOT signed and completed in black ink)

Valid ID (copies can be made at the library)

Passport Photo

Original Birth Certificate

Other…

What method will you use to pay for the fees to the Lindenhurst Memorial Library?

Please note the library charges a $35 execution fee for each application.

Card

Cash

Check

What method will you use to pay for the fees to the Department of State?

Please note the Department of State only accepts checks or money orders. Checks can be written at the time of the appointment after the final price has been verified by the Acceptance Agent. For further information on Department of State fees please go to: https://travel.state.gov/content/travel/en/passports/how-apply/fees.html

Check

Money Order

Which day(s) would you prefer to have your appointment?

After we recieve your request for an appointment, and agent will call you to confirm the time and date. We are currently holding weekly appointment hours on Tuesday and Thursday evenings, as well as Monday afternoons on a monthly basis.

Tuesday

Appointment hours are 5:15pm and 6:15pm

Thursday

Appointment hours are 5:15pm, 6:15pm, and 7:15pm

No preference

Other

I have a scheduling conflicts and would like to talk to an agent about my options

Are there any language or accessibility needs that you would like us to be aware of?

Are there any additional questions you have for us before your passport appointment?

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