Asylum Intake Form - Powers Law Group

Please fill out the form as best you can at least 30 minutes before the consultation.
Alien's Information
Alien's Full Name*

First NameLast Name
Birth Date

MonthDayYear
Country of Birth
Country of Citizenship
Visa Status, if any
Contact Information
E-mail
ex: myname@example.com
Phone Number*

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Skype
Background Information
Have you ever served in the military?

YesNo
What type of asylum are you seeking? *

RaceReligionNationalityPolitical OpinionMembership in a particular social group
Have you been harmed by your government or by someone that your government will not or cannot control? *

YesNo
If yes, give brief description about your persecution or abuse. You may also copy and paste your personal statement into the box if you already have one.*
Entries and Exits
Alien's First Entry into US (MM-DD-YYYY) Approx.
How did you enter?
Alien's Last Entry into US (MM-DD-YYYY) *
How did you enter?
Alien's Last Visit to home country? (MM-DD-YYYY) *
Legal History ( from immigrant's point of view)
Have you ever been detained by the police or immigration?
Are you now or have you ever been in removal proceedings?

YesNo
Have you ever committed any crimes?

YesNo
If yes, explain:
Have you ever made a false claim to US citizenship?

YesNo
Have you ever committed any fraud to immigration?

YesNo
Have you ever applied for asylum?

YesNo
Have you previously applied for an Immigration Petition?

YesNo
Have you ever been refused entry into the US?

YesNo
Relationships
Are you currently married?

YesNo
Do you currently have any children?

YesNo
Conclusion
Overall goal of consult/ what is the main issue that needs to be resolved during consult?*
How did you learn about the law firm?*
Other
Name of the person completing the intake sheet:
Date (MM-DD-YYYY)
At which of our locations will your consultation take place?
How would you prefer your consultation?
Would you like to receive immigration updates through our Newsletter?

YesNo, thank you.
Should be Empty:

Please fill out the form as best you can at least 30 minutes before the consultation.

Alien's Information

Contact Information

Background Information

Entries and Exits

Legal History ( from immigrant's point of view)

Relationships

Conclusion