Immigration Intake Questionnaire

 
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  • PLEASE DO NOT WRITE/PRINT ON BACK OF PAGES
  • NO PERSONAL CHECKS are accepted for Initial Consultations. (In person consultation fee can be paid in Cash, Money Order, Cashier’s Check, or via Online Payment/PayPal.)
  • It is important to the evaluation of the case that you complete this Questionnaire accurately, truthfully and completely. We assure you that the information supplied by you (whether or not you retain our services) is strictly confidential.
  • PLEASE PRINT LEGIBLY, USING BLUE or BLACK INK.
  • If filling out online, you must check "certification box" at end of questionnaire.
INFORMATION ABOUT PERSON WITH IMMIGRATION PROBLEM (“CLIENT”)
Client’s Full Name

(Exactly as it appears on the birth certificate):

Name Client is currently using:
Other names used

(Maiden, Married, Religious, Professional, Assumed, Aliases):

Did client enter the U.S. under an “assumed or fake name”?
Client’s Present Address
Client’s Contact Information
Alternate contact person for client in U.S. in case client cannot be reached:

(Should be different from client’s contact info.)

Client’s Date of Birth:
Client’s Birthplace
Client’s Marital Status
(whether Church, civil, or “secret” marriage)?
Marital History
Marriage