1. *Your Name:
2. *Your Email Address:
3. If you are asking about legal services for another person (e.g. a friend or family member), please list that person's name. If you need legal services, leave this blank:
4. Address:
5. Telephone:
6. Alien number (begins with an "A"):
7. Country(ies) of citizenship and nationality:
8. Date of birth:
9. Current Immigration Status:
   green card   none   temporary visa   other
10. Spouse:
    Lawful Permanent Resident (green card)   U.S. citizen   fiance(e) with green card or U.S. citizenship   none
11. All other relatives with U.S. immigration status, including children. Please indicate each person's immigration status, and if they have filed an immigration petition on your behalf, indicate its date and current status (ie, approved, pending, etc.)
    NAME (INCLUDE CHILDREN'S AGES) | RELATIONSHIP | PETITION FILED? | PETITION'S DATE AND STATUS
    
12. Entry/exit history: include date(s) of entry/exit, what status admitted in (e.g., type of visa, advance parole, illegal border crossing), and the date(s) the visa or I-94 period expires/expired
    DATE(S) | STATUS | EXPIRATION DATE OF VISA/I-94
    
13. Work Permit:
    still current, first issued on:
    expired on:
    never had one
14. Applications you have filed in the past, and the dates they were filed:
    ABC
    TPS
    Amnesty
    SAW
    Asylum
    NACARA
15. Immigration Violations: Please include all dates for any event(s) listed, even if it occurred more than once
    choices:
    I am currently attending Immigration Court proceedings. The next date for my court is .
    I was granted voluntary departure by a judge on
    I was ordered removed by a judge on
    I was physically turned around at the U.S. border by INS/immigration agents on
16. If you have had an employer file a labor certification/PERM/I-140 application for your green card, please briefly explain the employer's name, the employment position, the date of the petition, and its current status (ie, approved, pending, etc.)
    
17. Criminal History: this includes convictions, arrests, and minor infractions/tickets. For each, please provide the date, the specific criminal code section (if you know it), and a brief description of the offense.
    
18. *What is your general concern/question?:
    

The above information is being provided for case evaluation purposes only. To retain the law firm to provide services other than to evaluate your case, a separate agreement must be signed by the client and the attorney