Immigration Law Intake Form
Contact Number
Contact Number
Contact Number
Contact Number
"Before we get started, please keep in mind we do NOT give any type of legal advice. We only bring lawsuits."
**Wait for a response. **
"Thank you for your time. Unfortunately, there's not much we can do at this time but if you do change your mind, please do not hesitate to contact us."
IF THE ANSWER IS NO, READ THIS.
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Name of Person Doing the Intake
Date
-
Month
-
Day
Year
Date
Client Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Preferred Language:
Gender
Please Select
Male
Female
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Employment Details
Occupation
For how long?
Race/Ethnicity you identify yourself with:
Nationality
Employer's Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Any limitations on contacting you (Email not secure? Cell phone not secure? Etc.)
Driver’s State/License#_
Social Security #
Educational Background
Served in the Armed Forces
Civil Status
If you have children, how many?
Whom the children live with?
What, if there's any medications you take
Name of Significant Other
Relationship to you
Living in the same address?
How Long?
Contact Number (Significant Other)
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Immigration Form
When did you get to the country?
What's your legal status?Undocumented/illegal/overstayed visa* Documented*
How did you enter the country?
Have you received any letters from immigration?
Are you a minor (under age 18)?
Did you enter the country with a minor?
How many entries have you done into the US? Include Date/Method/Duration
What type of procedure are you looking for assistance with?
Asylum
Green Card
Removal Proceeding
Visas
Employment Visas
UVisas
Request for Evidence
Naturalization (Citizenship)
VAWA (Violence Against Women Act)
COMMENTS THAT MAY BE OF VALUE TO YOUR CASE
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