General Intake Form

Use the General Intake Form to provide some essential information about your situation to better assist you with your immigration requirements and procedures.

Please ensure you have digital scan copies of your Passport and/or Visa.

Referred By
First Name (required)
Middle Name
Last Name (required)
Your Email (required)
Address in US
How long have you lived in the US?
Have you applied for U.S. citizenship? If so, when and where?
Country lived in before U.S.
Place of Birth
Date of Birth
Relatives in the U.S. and legal status:
If with visa, what type and when does/did authorized stay expire?
Copy of Visa and I-94
List all entries and exits of the U.S. (Give dates, and whether went through Immigration Services inspection on entries into the US?
Have you applied for an extension of your visa?
YesNo
Are you married?
YesNo
When did you get married?
Where did you get married?
Name of spouse, status, date married:
Name of previous spouse, status, date marriage ended:
Do you have children? What are their Name, Date and Place of Birth?
Employment in US: dates and type of employment, name & address of employer
Please list your skills.
Have you ever applied for permanent residency, asylum, amnesty, TPS, cancellation, suspension, Family Unity or any other immigration benefit? When and how:
Have you ever had trouble with the police or been arrested in the US? If so when and for what?
Have you ever been a victim of a crime in the US? If so, what happened?
Have you ever had any contact with the Immigration Services or Border Patrol? If so, when and what happened?
Have you ever gone before an immigration judge? If so, when and what happened?
Have you ever been ordered deported, excluded, or been given voluntary departure? If so, did you leave and in a timely manner?
Do you have any reason to fear going back to your country? Who do you fear and why?