Client Intake Form

Your Full Name*

First Name Middle Name 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*

Please provide a Gmail if possible since Only Gmail can access Client Portals. If you provide a Non-Gmail Email, you will not have Client Portal Access if you hire us.

Secondary Email

(If Any)

Height*

Weight*

Hair Color*

Eye Color*

Are you Hispanic?*

Race? (Select all applicable boxes)*

White
Asian
Hispanic
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

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

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

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

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)	Temrinated 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

Date of Death of Mother:*

MM

DD

YYYY

Your Mother’s Current Address

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

Your Father’s Full Name

First Middle Last

Your Father’s Date of Birth

Your Father’s Place of Birth

City State / Province / Region Country

Is your Father alive?*

Yes
No

Date of Death of Father:*

MM

DD

YYYY

Your Father’s Current 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.

Yes
No

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

(If you do not have a Social Security Number, then you would not have a Credit Report.)

Do you have Health Insurance?*

Yes
No

Effective October 15, 2019, Immigration requires a Credit Report when performing a filing to give someone a Green Card. Additionally, Proof of Health Insurance would also be requested for everyone. Such Documents can be provided below:

Drop files here or

Checking your Credit does not lower Credit Score. You are able to receive one free credit report from the Credit Agency per year. You can pull your credit report every 4 months, if you alternate Credit agencies. Credit Reports may be ordered online from www.annualcreditreport.com. Our office only needs 1 of the 3 Credit Reports in every Green Card Filing. You may upload it here or provide it later at the request of the Law Firm.

Regarding Health Insurance, you would be required to provide Health Insurance Policy, IRS Form 1095-B or 1095-C, or Military Dependent ID (to prove TRICARE).

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:
-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.

Name

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

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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