Please fill out the form as best you can at least 30 minutes before the consultation.
Alien's Information
Alien's Full Name
*
First Name
Last Name
Birth Date
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Month
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Day
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1920
Year
Country of Birth
Country of Citizenship
Visa Status, if any
Contact Information
E-mail
ex: myname@example.com
Phone Number
*
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
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Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
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Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
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Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
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Democratic Republic of the Congo
Denmark
Djibouti
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Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
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Gibraltar
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Greenland
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Guadeloupe
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Indonesia
Iran
Iraq
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Israel
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Japan
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Jordan
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Kenya
Kiribati
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Libya
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Lithuania
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Macau
Macedonia
Madagascar
Malawi
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Maldives
Mali
Malta
Marshall Islands
Martinique
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Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
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
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Skype
Background Information
Have you ever served in the military?
Yes
No
What type of asylum are you seeking? *
Race
Religion
Nationality
Political Opinion
Membership in a particular social group
Have you been harmed by your government or by someone that your government will not or cannot control? *
Yes
No
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?
Yes
No
Have you ever committed any crimes?
Yes
No
If yes, explain:
Have you ever made a false claim to US citizenship?
Yes
No
Have you ever committed any fraud to immigration?
Yes
No
Have you ever applied for asylum?
Yes
No
Have you previously applied for an Immigration Petition?
Yes
No
Have you ever been refused entry into the US?
Yes
No
Relationships
Are you currently married?
Yes
No
Do you currently have any children?
Yes
No
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?
*
Please Select
Repeat Client
Google
Word of Mouth/Friend
Yahoo
Avvo
Bing
Facebook
LinkedIn
Other
Other
Name of the person completing the intake sheet:
Date (MM-DD-YYYY)
At which of our locations will your consultation take place?
Houston, TX
Hackensack, NJ
How would you prefer your consultation?
In Person
Phone
Skype
Would you like to receive immigration updates through our Newsletter?
Yes
No, thank you.
Submit
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