Immigration Intake

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Address:






Section 1

1. Were you born after June. 15, 1981?
If yes, what date?

2. Did you come to the United States before your 16th birthday?

3. Have you continuously resided in the U.S. since June 15, 2012?

4. Were you physically present in the U.S. on June 15, 2012?

5. Are you currently physically present in the U.S.?

6. Did you enter the U.S. without inspection before June 15, 2012 or lose your lawful status as of June 15, 2012?

7. Are you currently in school, have graduated or obtained a certificate of completion from high school, have obtained a general education development (GED) certificate, or are an honorably discharged veteran of the Coast Guard of Armed Forces of the United States?

8. Have you been convicted of a felony or misdemeanor?

Section 2

1. When was the first time that you entered the U.S.?

2. When was the most recent time that you entered the U.S.?

3. Are you married?
If yes, is your spouse a:

4. Do you have any children or step-children?
If yes, please list children: name, date of birth, and place of birth.

5. Are either of your parents a U.S. Citizen or Lawful Permanent Resident?
Mother:
Father:

6. Are any of your siblings US Citizens or Lawful Permanent Residents?

7. Has any immigration petition ever been filed for you or your parents?

8. Have you ever been deported from the U.S.?


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