Immigration Intake Questionnaire

Please fill out to the best of your ability.

First Name *

Last Name *

Phone *

Email

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Preferred language *

English

Spanish

Address

Street Address

City

State

Country

Country

Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo, The Democratic Republic of the
Cook Islands
Costa Rica
Cote D"Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See (Vatican City State)
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran, Islamic Republic Of
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea People's Democratic Republic
Republic of Korea
Kuwait
Kyrgyzstan
Land Islands
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Jamahiriya
Liechtenstein
Lithuania
Luxembourg
Macao
North Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Federated States of Micronesia
Moldova, Republic of
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian Territory, Occupied
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russian Federation
Rwanda
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Eswatini
Sweden
Switzerland
Syrian Arab Republic
Taiwan
Tajikistan
Tanzania, United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
UK
Ukraine
United Arab Emirates
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
No elements found. Consider changing the search query.
List is empty.

Postal code

Date of birth *

Alien Number (If applicable)

Fecha de nacimiento *

Numero de Alien (Si aplica)

Legal Status *

Ex. Citizen, Resident, No Status, DACA

Place of Birth *

Estatus legal *

Ej. Ciudadano, Residente, Sin Estatus, DACA

Lugar de nacimiento *

Marital Status

Please choose one

Married
Single
Divorced
Separated
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List is empty.

Spouse's name *

Estado civil

Favor de elegir uno

Casado(a)
Soltero(a)
Divorciado(a)
Separado(a)
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List is empty.

Nombre de pareja *

What is your spouse's status? *

US Citizen

Permanent resident

VISA

DACA

No status

Estatus legal de pareja *

Ciudadano(a)

Residente permanente

VISA

Daca

Ningun estatus

Please choose what best fits your matter *

Please choose one

Adjustment of Status (Marriage)
Adjustment of Status (Family)
Asylum
Consular Processing
DACA
Employment Visa
FOIA Request
Humanitarian Parole
Naturalization
Removal Proceedings
U Visa/T Visa
VAWA
Waiver
No elements found. Consider changing the search query.
List is empty.

Por favor elija el que mejor quede a su caso

Favor de elegir uno

Ajuste de estatus (Matrimonio)
Ajuste de estatus (Familia)
Asilo
DACA
Proceso consular
Visa de trabajo
Renovacion de residencia
Naturalizacion
Libertad condicional humanitaria
Visa U/Visa T
Perdon
Procedimientos de deportación
No elements found. Consider changing the search query.
List is empty.

Please describe what you are seeking an immigration lawyer for *

Por favor describa la razón que busca un abogado de inmigración *

Do you have children who are US Citizen(s)?

Please choose one

Yes
No
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If yes, please include name(s) and age *

(Ex. Name age, name age)

Tiene hijo(s) que sean ciudadanos?

Si
No
No elements found. Consider changing the search query.
List is empty.

Si eligio Si, incluya sus nombres y edades

(Ej. Nombre Edad, Nombre Edad)

Is the prospective client in-custody? *

Yes

No

Client name *

A number (If applicable)

Está el cliente potencial bajo custodia?

Si

No

Nombre del cliente *

Numero A ( Si aplica)

How long have you been in the country without departing?

When did you first enter the country?

Cuando tiempo ha estado en el pais sin salir?

Cuando entro el pais por primera vez?

Have you ever been ordered to leave or have you been removed from the country?

Please choose one

Yes
No
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List is empty.

If yes, when? *

Alguna vez le han ordenado que salga o le han expulsado del país?

Favor de elegir uno

Si
No
No elements found. Consider changing the search query.
List is empty.

Si eligio Si, Cuando? *

Are you currently in immigration court?

Please choose one

Yes
No
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When is your next court hearing? *

What type of court is it? *

Please choose one

Master
Individual
Not sure
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Se encuentra actualmente en la corte de inmigración?

Favor de elegir uno

Si
No
No elements found. Consider changing the search query.
List is empty.

Cuando es su próxima audiencia judicial?

Qué tipo de tribunal/corte es?

Favor de elegir uno

Individual
Master
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Are you currently employed?

Please choose one

Yes
No
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List is empty.

Employer name

How long have you been employed?

Esta usted empleado actualmente?

Favor de elegir uno

Si
No
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List is empty.

Nombre del empleador

Cuanto tiempo lleva empleado?

FINANCIAL QUESTIONS FOR POSSIBLE PAYMENT PLAN OPTIONS.

PREGUNTAS FINANCIERAS PARA POSIBLES OPCIONES DE PLAN DE PAGO

What is your total monthly take home?

What is the highest monthly payment you can afford?

500

750

1000

Other

Do you have a checking account?

Please choose one

Yes
No
No elements found. Consider changing the search query.
List is empty.

Do you have any of the following credit cards?

MasterCard

VISA

AMEX

Discover

Other

How did you hear about us? *

How did you hear about us?

Google/Internet
Referral
Previous/Current Client
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If referred, by who?

Referral Name *

Cuál es su ingreso total mensual?

Cuál es el pago mensual más alto que puede pagar? *

500

750

1000

Otro

Tiene cuenta bancaria?

Favor de elegir uno

Si
No
No elements found. Consider changing the search query.
List is empty.

Tiene alguna de las siguientes tarjetas de crédito?

MasterCard

VISA

AMEX

Discover

Otra

Cómo te enteraste de nosotros? *

Favor de elegir uno

Google
Referido
Cliente Previo/Actual
No elements found. Consider changing the search query.
List is empty.

Nombre de referencia *

PLEASE REVIEW THE FOLLOWING INFORMATION RELATING TO YOUR INQUIRY ABOUT POSSIBLE LEGAL REPRESENTATION BY THE FIRM.

POR FAVOR REVISE LA SIGUIENTE INFORMACIÓN RELACIONADA CON SU CONSULTA SOBRE POSIBLE REPRESENTACIÓN LEGAL POR PARTE DE LA FIRMA.

ENGLISH

You acknowledge that the individual conducting this consultation is a legal administrator and not a licensed attorney. This meeting is for the purpose of gathering information regarding your case.

No attorney-client relationship is established by submitting this form or participating in this consultation. An attorney will review your information to determine whether the firm will accept your case. No legal advice will be provided during this process.

You further understand that no staff member or representative of the firm can provide legal advice, make guarantees, or promise specific results until you become an official client of the firm by signing a formal agreement.

By signing below, you acknowledge and agree to the terms outlined above.

Español

Usted reconoce que la persona que realiza esta consulta es un administrador legal y no un abogado colegiado. Esta reunión tiene como objetivo recopilar información sobre su caso.

El envío de este formulario o la participación en esta consulta no establecen una relación abogado-cliente. Un abogado revisará su información para determinar si el bufete acepta su caso. No se le proporcionará asesoramiento legal durante este proceso.

Además, comprende que ningún miembro del personal ni representante del bufete puede brindarle asesoramiento legal, ofrecer garantías ni prometer resultados específicos hasta que se convierta en cliente oficial del bufete mediante la firma de un acuerdo formal.

Al firmar a continuación, usted reconoce y acepta los términos descritos anteriormente.

I acknowledge and agree to the terms of the disclosure above. Reconozco y acepto los términos de la divulgación anterior. *

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