Client Intake Form

Your Full Name (First):*

First Name

Your Full Name (Middle):*

Middle Name

If no middle name, please type NMN or NA

Your Full Name (Last):*

Last Name

Have you ever had any other name?*

Yes
No

Your Birth Name*

First Name Middle Name Last Name

Any Other Names Used:

First Name	Middle Name	Last Name

Gender?*

Do you want to Change your Name to the Married Name?*

Changing Name to Married Name

Please write your name EXACTLY how you would like it to appear on the Immigration Document:

First Middle Last

Date of Birth*

Home Phone*

Mobile Phone*

Email*

Secondary Email

(If Any)

Height*

Weight*

Hair Color*

Eye Color*

Are you Hispanic?*

Race? (Select all applicable boxes)*

White
Asian
Black or African American
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander

Do you live inside the US or Abroad?*

Inside the US
Abroad

Full Address (Inside the US)

Street Address APT/FL/STE/LOT City State ZIP Code

Date you Moved Into that Address:*

MM

DD

YYYY

Is the above residential address the same as your Mailing Address?*

Yes
No

Please briefly explain why the address are different?

Mailing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Full Address (Outside of the US)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Date you Moved Into that Address:*

MM

DD

YYYY

International Phone Number or Phone Number used Abroad:*

Place of Birth*

City State / Province / Region Country

Country of Citizenship*

Country

Secondary Country of Citizenship (if any)

Country

Are you an Active Duty US Service Member?*

Yes
No

Active Duty with the US Army, National Guard, Navy, Marine Corps, Air Force, Coast Guard, or Space Force.

Active Duty Service:

Branch	Duty Station	Rank	Enlistment Date	Expected Discharge Date

Are you a Reservist or Veteran of the US Armed Forces?*

Yes
No

Reservist or Veteran Service:

Branch	Duty Station or Last Duty Station	Rank	Enlistment Date	Expected Discharge Date of Discharge Date

Entry in the US Information

Are you Currently in the US?*

Yes
No

Date of Last Entry

MM

DD

YYYY

Type of Visa Used

Place of Entry

(City and State) or (Airport) or (Border Checkpoint)

Marriage and Children Section

Are you Married?*

Number of Previous Marriages*

Please enter a number from 0 to 5.

Note: Please place "0" if you have zero prior marriages.

Example: If you are on your Second Marriage, then you would have "1" Previous Marriage, and you would state "1"

Current Spouse or Partner’s Full Name*

First Middle Last

Fiance’s Full Name

First Middle Last

For Fiancees, is the Fiance entering the US on a K-1 Visa, Spousal Visa, or already in the US?

Future K-1 Fiancee Visa
Me and My Fiancee will Marry abroad and they will enter on a Spousal Green Card Visa
My Fiance is already in the US and we will pursue a Green Card Filing in the US or at a US Consulate
(Other) I do not know how to answer

Reminder: Spousal filings require marriage.

Note: Marriage would be required for a spousal filing

Current Spouse or Partner's Date of Birth*

Current Spouse or Partner's Place of Birth*

City State / Province / Region Country

Date of Current Marriage*

Place of Current Marriage

City State / Province / Region Country

Previous Marriage Information

Full Name of Prior Spouse	Date of Birth	Male or Female	Place of Birth (City/State/Country)	Terminated by Death, Divorce, Annulment?	Date of Termination

Please provide Dates as: (MM/DD/YYYY)

Do you have any Children?*

Children

Child's Full Name	Date of Birth	Place of Birth (city/state/country)	Child's Current Address

Please list dates as (MM/DD/YYYY)

Your Parent Information

Your Mother’s Full Name*

First Middle Last

Your Mother’s Date of Birth

Your Mother's Place of Birth*

City State / Province / Region Country

If your Mother alive?*

Yes
No
Unknown

Date of Death of Mother:

MM

DD

YYYY

Your Mother’s Current Address

Same as my address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Your Father’s Full Name (if you know who your father was)

First Middle Last

Note: If father is not known, please state UNKNOWN.

Your Father’s Date of Birth

Your Father’s Place of Birth

City State / Province / Region Country

Note: If father's place of birth is not known because you do not know who your father is, please state UNKNOWN. If you know who your father is, the place of birth information is required.

Is your Father alive?*

Yes
No
Unknown

Date of Death of Father:

MM

DD

YYYY

Your Father’s Current Address

Same as my address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Were your parents ever married?*

Yes
No

Place of Marriage of Parent:

(City/State/Province/Country)

Date of Marriage

MM

DD

YYYY

Address and Work History

Your Address History since you were 16 or for the past 5 years (whichever is longer)*

Full Address (Street, City, State/Province, Country, Zip/Postal Code)	Move-in Date (MM/DD/YYYY)	Move-out Date (MM/DD/YYYY)

Please provide your Histories to the best of your abilities. The Dates do not have to be exact.

Example: If you remember 2010 as a date, but nothing else, our office will turn the 2010 into 01/01/2010 since that covers all of the year.

Last Address Abroad (Outside of the US)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Last Address Abroad (Dates)*

Move-in Date (MM/DD/YYYY)	Move-out Date (MM/DD/YYYY)

Your Employment History since you were 16 or for the past 5 years (whichever is longer) - Also please include Current Employment and Any Periods of Education*

Name of Employer or School	Full Address	Job Title or Degree	Start Date (MM/DD/YYYY)	Stop Date (MM/DD/YYYY)

You can Include "times when you were a Student," periods of "Unemployment," and when you started "Retirement"

Last Employment Abroad*

Name of Employer	Full Address	Job Title	Start Date (MM/DD/YYYY)	End Date (MM/DD/YYYY)

Please Complete even if provided above. This question is asked in 100% of Initial Green Card Filings.

Crimes, Deportation, and Prior Filings

Have you ever petitioned for another person in an Immigration filing? (such as a Family, Fiance, or Spousal Filing)*

Yes
No

Please Provide Further Information about the other filings:*

Full Name	Date	Purpose for filing	Location of Filing	Outcome of Filing

Have you ever been stopped, arrested, detained, placed in handcuffs, charged, punished, or convicted by law enforcement anywhere in the world?*

Regardless if it was dismissed, sealed, or expunged.

If Yes, and you are the person receiving the immigration benefit, then you MUST request Certified-copies of the Police and Court Records ASAP for EVERY case, and such records must be provided to the Law Firm. This is 100% your responsibility and mandatory in all Immigration Filings.

No
Yes
Yes, I cannot Remember the specifics or how many occurred, and will perform an FBI Background Check. Link found here: https://www.edo.cjis.gov/#/

Further Information is required*

Crime	Date	City	State	Outcome

Would you like to add any comments?

If Yes, and you are the person receiving the immigration benefit, then you MUST request Certified-copies of the Police and Court Records ASAP for EVERY case, and such records must be provided to the Law Firm. This is 100% your responsibility and mandatory in all Immigration Filings.

Have you ever been in Removal or Deportation Proceedings in the US?*

Yes
No

If Yes, and you are the person receiving the immigration benefit, then you must explain and provide as much detail as possible:

Have you ever worked in the US without Work Authorization?*

Yes
No

To ask another way, have you ever lied to an employer to work in the US, when you were not supposed to?

This question also considers the I-9 Form.

Have you ever lied on a USCIS I-9 Employment Authorization Verification Form?*

No
Yes

If you have ever marked "US Citizen" or "US National" on the I-9 Form, you should immediately notify the Law Firm since you may be permanently barred from receiving a Green Card and you may be Deportable.

Have you ever stated or pretended to be a US Citizen?*

No
Yes

On an I-9 Form, Driver's License Application, Social Security Application, Tax Documents, Employment Documents, Mortgage Documents, ect.

US Credit Report and US Health Insurance

Have you ever requested your Credit Report?

Yes
No

(Even if you do not have a Social Security Number or don't have credit, the Credit Reporting Agencies can provide a report. This document is Mandatory by Immigration for many filings starting February 24, 2020.)

Do you have Health Insurance?*

Yes
No

Passport-styled Photo

Please upload a Passport-style Photo of yourself:

Nearly Every Immigration Filing requires a 2x2 Passport Styled Photo. Instead of wasting money, we invite every client to take a "Selfie" with a phone and provide that photo to our office.

Photo Requirements:
- Photo taken within the past 30 days
-Only one person in the photo
-White background
-No smiling
-Hair behind your ears
-No shadows or darkness in the background
-No glasses

If you choose to not send a photo with this intake, please send us a passport-styled photo as soon as possible when/if you hire our Law Firm. Providing a Passport-styled Photo is frequently "forgotten" by clients and it can cause a few-day delay when clients wait until the last minute to provide the Passport-styled Photo.

Phone

This field is for validation purposes and should be left unchanged.

Entry in the US Information

Marriage and Children Section

Your Parent Information

Address and Work History

Crimes, Deportation, and Prior Filings

US Credit Report and US Health Insurance

Passport-styled Photo

Practice Areas

Associations

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