Immigration Intake Questionnaire

Immigration Intake Questionnaire

Name:

Phone Number:

Address:

Email address:

Best Time to Contact:

1. Were you born after June. 15, 1981?

YesNo

If yes, what date?

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

YesNo

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

YesNo

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

YesNo

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

YesNo

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

YesNo

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?

YesNo

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

YesNo

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?

YesNo

If yes, is your spouse a:

U.S. CitizenLawful Permanent ResidentNone of The Above

4. Do you have any children or step-children?

YesNo

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:

U.S. CitizenLawful Permanent ResidentNone of The Above

Father:

U.S. CitizenLawful Permanent ResidentNone of The Above

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

Sister:

U.S. CitizenLawful Permanent ResidentNone of The Above

Brother

U.S. CitizenLawful Permanent ResidentNone of The Above

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

YesNo

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

YesNo

9. Comments: