Download Immigration Intake Form

A Tradition of Fine Lawyering
IMMIGRATION, CRIMINAL DEFENSE, FAMILY LAW & DIVORCE, ESTATE PLANNING
VINCENT P. MARTIN ZACHARY AAKER MARIA TRAFTON ROBERT A. YARD* MAURY D. BEAULIER*
AYAN AHMED: LEGAL ASSISTANT SARA KETTERING: PARALEGAL CYNTHIA HERMES: OFFICE ASSISTANT *OF COUNSEL
GENERAL IMMIGRATION QUESTIONNARE
Date: _________________________________
Conflicts:______Initials:_________
Name: _______________________________________________________________________________________________________
Address (complete – street address, apartment number, city, state and zip code):
_____________________________________________________________________________________________________________
Contact Number: _______________________________________________________________________________________________
E-Mail: _______________________________________________________________________________________________________
Would you like to receive our Immigration Newsletter regarding the latest immigration news?
YES
NO
Date of Birth: ______________________________________ Place of Birth: _______________________________________________
Occupation: ____________________________________ Employer Name: _______________________________________________
Employer Address: _____________________________________________________________________________________________
Spouse/Fiancé(e) Name (if applicable): _____________________________ Spouse’s/Fiance(e)’s date of birth:____________________
Spouse’s/Fiancé(e)’s country of residence/citizenship (if applicable):______________________________________________________
When did you arrive in the United States? ___________________________________________________________________________
Do you have legal immigration status in the United States?..........................................................................................
If yes, what status? ________________________________
Did you enter the U.S. legally?.................................................................................................................................
Have you ever been sent back to your home country or ordered to leave
the United States by any U.S. government official?..........................................................................................
Do you have a parent or grandparent who is/was a United States Citizen or
Legal Permanent Resident?......................................................................................................................................
Since your arrival in the United States, have you worked?......................................................................................
Have you (or has anyone else) ever submitted an application or petition of any kind
to U.S. Immigration to help you, your spouse, an ex-spouse, or any of your children
to get legal immigration status in this country?.................................................................................................
Have you ever been married?...................................................................................................................................
If yes, what is his/her immigration status? ________________
Have you ever been accused of a crime or offense and/or arrested anywhere in the world?....................................
If this is a marriage based case, do you have questions about a Prenuptial Agreement?..........................................
Do you have any questions about divorce or criminal defense?.............................................................................
Have you spoken with another attorney regarding your case?..................................................................................
Have you hired another attorney?..............................................................................................................................
U-Visa eligibility - have you been the victim of a crime?....................................................................................................
YES
NO
YES
NO
YES
NO
YES
YES
NO
NO
YES
YES
NO
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
Briefly explain the reason you are here today: ________________________________________________________________________
_____________________________________________________________________________________________________________
How were you referred to our office? _____________________ Provide website if found online:_______________ ________________
_____ Initial Here – The consultation fee is $60.00. I understand that this initial consultation does not create an attorney/client
relationship. I understand that Cundy and Martin, LLC is not my attorney and that I should not rely on any information from this initial
consultation as legal advice. All information provided is confidential.
DEFERRED ACTION FOR CHILDHOOD ARRIVALS (DACA)
Did you enter the U.S. before your 16th birthday?..................................................YES/NO
Were you under the age of 31 as of June 15, 2012…………………………….…YES/NO
Have you continuously resided in the U.S. since June 15, 2007 up to
the present time? ………………………………………………………………… YES/NO
Had no lawful status on June 15, 2012?.................................................................YES/NO
Are you currently in school, have you graduated or obtained a certificate
of completion from high school, have you obtained a general
education development (GED) certificate, or are you an honorably
discharged veteran of the Coast Guard or Armed Forces of the
United States?.......................................................……………………………….. YES/NO
Have you been convicted of a felony, significant misdemeanor,
or three or more other misdemeanors, and do not otherwise pose
a threat to national security or public safety?........................................................ YES/NO
_________________________________________________________________________