Immigration Intake FormPlease answer all questions fully and honestly. The answers may affect your case. YOUR ANSWERS TO THE QUESTIONS ARE COMPLETELY CONFIDENTIAL AND WILL NOT BE RELEASED TO ANYONE WITHOUT YOUR PERMISSIONPlease enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Client Name *FirstMiddleLastReferred By *Phone Number *Email *Address *Date of Birth *Place of Birth *Nationality *When did you FIRST enter the United States?When did you LAST enter the United States?How did you enter the LAST time?Visa EntryBorder Crossing without checkpointBorder Crossing with checkpointList all entries to and exits from the United States Do you have a I-94?YesNoIf you choose Yes, what is/was the expiration date?Have you ever been ordered removed or deported from the United States?YesNoHave you ever appeared in an immigration court? *YesNoHave you ever been stopped by immigration officials? *YesNoHas any paperwork been filed with USCIS or Immigration Court on your behalf? *YesNoIf you answered Yes to any of the above, please describe. below *Have you ever applied for any immigration benefit? *YesNoIf so, please describe the type of benefits, date of applications and the outcome.. *Are you a U.S. citizen or permanent resident? *Yes - US CitizenYes - Permanent ResidentNoAre your parent(s) or grandparents U.S. citizens? *Yes - US Citizen (Parent)Yes - Permanent Resident (Parent)Yes - US Citizen (Grandparent)Yes - Permanent Resident (Grandparent))NoAre you currently married? *YesNoDate and place of current marraige *Do you have children in the United States? *YesNoIf so, please provide their names, ages, place of birth, and immigration status *Do you have any other family members in the United States? *YesNoIf so, please provide their names, your relation, and immigration status *Have you ever had trouble with the police or been arrested in the United States? *YesNoIf so, please provide details as to when it happened, what happened, and whether or not you served any jail sentence *Do you have any reason to fear going back to your country?YesNoWho do you fear and why?Have you ever been a victim of domestic abuse by a spouse, parent, or child?YesNoHave you ever been threatened or harmed by a spouse, parent, or child?YesNoIf so, did your spouse, parent or child have U.S. citizenship status or lawful permanent resident?Yes - US CitizenYes - Permanent ResidentNoHave you ever been the victim of a crime?YesNo of ages, Date If so, provide details to the crime experiencedDid you report the crime to the police or help with the criminal investigation or prosecution?YesNoDid anyone recruit you in your home country to work in the United States?YesNoDid you feel forced to work or tricked into working in the United States?YesNoWere you required to work without pay? (or less pay than allowed or expected)?YesNoHave you been abandoned, abused, or neglected by a parent?YesNoAre you currently under the jurisdiction of a juvenile court (dependency, delinquency, or probate guardianship)?YesNoWhat issues/problems have brought you to this law firm? What outcome are you hoping to accomplish? *Submit