Deferred Action for Parental Accountability (DAPA)

Please fill out the form as best you can at least 30 minutes before the consultation.
Your answers will be kept strictly confidential. Please answer these questions accurately to the best of your ability.
Deferred Action for Parental Accountability (DAPA) of U.S. citizens or lawful permanent residents will begin May 19, 2014. The filing fee is $465.
Contact Information
E-mail
Phone Number*

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Skype
Alien's Information
Alien's Full Name*

First NameLast Name
Birth Date

MonthDayYear
Country of Birth
Visa Status, if any
Have you ever served in the military?

YesNo
Marital Status
If married, is your spouse:
Do you have any U.S. citizen children or lawful permanent resident children born before November 20, 2014?

YesNo
If yes, please list the name and date of birth of each child:
Entries and Exits
Alien's First Entry into US (MM-DD-YYYY) Approx.
How did you enter?
Where did you enter (city, state)?
Alien's Last Entry into US (MM-DD-YYYY)
How did you enter?
Requirements for Deferred Action
Have you continuously resided in the United States since January 1, 2010?

YesNo
Were you present in the United States on November 20, 2014?

YesNo
Have you left the US since Jan 1, 2010?

YesNo
If yes, please explain:
Have you been convicted of a felony offense, a significant misdemeanor offense, multiple misdemeanor offenses, or otherwise pose a threat to national security or public safety?

YesNo
If so, please explain and bring records to the consultation.
What was your immigration status on November 20, 2014?
Have you filed your tax returns for the past five years?

YesNo
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
If yes, explain:
Have you ever been refused entry into the US?

YesNo
Have you ever been apprehended at the border while attempting to unlawfully enter the United States?

YesNo
If yes, please explain (gives dates, and circumstances surrounding unlawful entry):
Have you been convicted of three or more misdemeanors?

YesNo
If yes, please list the charge and date of the convictions.
Have you been convicted of domestic violence, sexual abuse, burglary, unlawful possession of firearm, drug distribution or trafficking, or driving under the influence?

YesNo
If yes, please list the charge and date of the conviction.
Have you ever spent 90 days or more in jail?

YesNo
If yes, please list the offense for which you served time in jail.
To the best of your knowledge, have you ever been issued a final order of removal?

YesNo
If yes, please list the date of the final order of removal.
The answers to the above questions I have provided are correct and true to the best of my knowledge.

YesNo
Conclusion
How did you learn about the law firm?
Other
Name of the person completing the intake sheet:
Date (MM-DD-YYYY)
Would you allow us to add you to our newsletter?

YesNo, thank you.
Should be Empty:

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

Deferred Action for Parental Accountability (DAPA) of U.S. citizens or lawful permanent residents will begin May 19, 2014. The filing fee is $465.

Contact Information

Alien's Information

Entries and Exits

Requirements for Deferred Action

Legal History ( from immigrant's point of view)

Conclusion