First Name
Last Name
E-Mail
Phone
Address
City
State
Zip
Nationality
Time in U.S.
Place of birth
Date of Birth
MM
DD
YYYY
Current U.S. Immigration Status (check one):
Citizen
Resident
Visa
Visa type (if applicable)
What type of immigration services are you seeking? Please be as specific as possible.
Family Members who are Residents or Citizens of the United States:
List all entries into and exits from the United States and the manner in which you entered & exited:
Name of spouse
Date of wedding?
Immigration status of spouse
Immigration status of fiancé(e)
Date(s) of prior divorce(s)
MM
DD
YYYY
MM
DD
YYYY
MM
DD
YYYY
Has anyone ever applied for immigration benefits on your behalf? If so, what application(s) was / were filed and when?
Arrests, charges of violating any U.S. law, unsatisfied legal obligations in the U.S. (if yes, please specify what happened and when)?
Fingerprints taken at the border?
Deportation or contact with immigration officer (if yes, please specify what happened and when)?
Fear of returning to home country (please give details)?
Fear of returning to home country (please give details)?
Victim of abuse or crime (please give details, including time of incident(s))?
Are you known by any other names? Include maiden name.
Yes
No
If yes, list other names you have used:
Do you have a job or offer from a U.S. employer?
Yes
No
If yes, please provide the employer's name and address, and a description of the job you have been offered.
Please set out the reason(s) you wish to enter, or remain in, the U.S.
If you are applying for a visa to enter the U.S., do you wish to bring members of your family with you?
Yes
No
Have you ever entered the U.S. on a visa other than a tourist visa?
Yes
No
If yes, please provide the dates you were in the U.S., and the type of visa used.
Have you ever been denied permission to enter the U.S., or ordered to leave the U.S.?
Yes
No
If yes, please give the reason and the relevant dates.
Have you ever been convicted of a crime (other than non-criminal traffic offense)?
Yes
No
If yes, please provide the details, including the offense for which you were convicted, the sentence or penalty imposed, and the date of the offense.
If you are now in the U.S., have you been ordered to leave, or do you believe you may be ordered to leave?
Yes
No
If yes, please provide the details, including the reason for the order.
Have other attorneys worked on this matter?
Yes
No
If yes, provide names, addresses, and a brief description of their involvement: