General Family-Based Case - Consultation Intake Form

Please fill out the form as to the best of your knowledge
Applicant/Immigrant's Information
Applicant/ Immigrant's Full Name *

First Name Last Name
Birth Date

Month Day Year
Country of Birth
Legal Status, if any
Applicant's E-mail
ex: myname@example.com
Applicant's Phone Number *

Area Code Phone Number
Applicant's Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Are either of the applicant/immigra nt's parents Legal Permanent Residents or Citizens?

Yes No
Has anyone ever filed a petition for the applicant /immigrant's parents or grandparents?

Yes No
Petitioner's Information
Petitioner's Full Name *

First Name Last Name
Birth Date

Month Day Year
Petitioner's Status

US Citizen Legal Permanent Resident Other
Petitioner's Phone Number

Area Code Phone Number
Petitioner's Email (needed for contracts)
example@example.com
Petitioner's Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
If US citizen, was the petitioner born in the US?

Yes, in a hospital Yes, with a midwife No, born abroad
Has the Petitioner ever served in the military?

Yes No
Background Information
Applicant/ Immigrant is Petitioner's

Fiance(e) Spouse Other
Date Married
Waiver/Consular Processing: How along are you with the case?

Nothing Filed Petition (I-130 or I-129F) is pending Petition is approved Done with NVC and waiting for the interview Consular interview has taken place I-601 (and/or I-212) is pending I-601 (and/or I-212) was denied
Entries and Exits
Applicant/Immigra nt's Last Entry into U.S.
(MM/DD/YYYY)
How did you enter?
Applicant's First Entry into U.S.
(MM-DD-YYYY)
How did you enter?
If more than two entries, please list all entries to the US.
Has the Applicant/Immigra nt ever applied or been issues a visa?

Yes No
If yes, please explain.
Legal History (from immigrant's point of view)
Have you ever been detained, cited, arrested, or stopped by the police or immigration?
Are you now or have you ever been scheduled to be before an immigration judge or have you ever been before an immigration judge?

Yes No
Have you ever committed any crimes?

Yes No
If yes, explain:
Have you ever made a false claim to US citizenship?(Including I-9 forms, voting registration)

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
Have you ever been forced to work or perform any labor without pay?

Yes No
Have you ever been forced to do anything (by employer, family, or friend) that made you feel uncomfortable?

Yes No
Have you or any of your family members ever received public benefits? Check all that apply.

SNAP Temporary Assistance for Needy Families (TANF) Section 8 Housing Medicare Supplemental Security Income Other
If other, explain:
Previous Relationships
Has the applicant previously been married anywhere in the world?

Yes No
If so, how many times?
Has the petitioner previously been married anywhere in the world?

Yes No
If so, how many times?
Have you ever filed taxes together?
Family
Number of Applicant's children (biological, adopted, step)
Number of Petitioner's children (biological, adopted, step)
Affidavit of Support (I-864 Form)
Petitioner Claims How Many dependents on Income Tax Return
Is the petitioner currently performing active military service?
Who will be the sponsor?
Enter Name
What is the sponsor's relationship to the Applicant?
What is the sponsor's current employment?

Employed on W2 Self-employed on 1099 Unemployed Retired Other
If other, explain:
If self-employed, does sponsor have a registered business? Does sponsor pay themselves separately from business?
Does sponsor earn enough according to poverty guidelines?

Yes No Unsure
Has the sponsor petitioned anyone in the past who is still a legal permanent resident?

Yes No Unsure
If yes, how many?
Will there be a joint sponsor?

Yes No Unsure
Victim of abuse or crime/asylee/refugee

If you are a victim of abuse or crime or are an asylee or refugee, please answer the following questions:
Are you now or have you ever experienced financial hardships?

Yes No Yes, but not anymore
Would it be extremely difficult for you to afford the immigration fees (filing fees) due to being either a minor or currently unemployed?

Yes No
If the above are YES, would you be able to provide evidence to prove financial hardship?

Yes No Maybe
Additional questions for beneficiary (Foreign National)
What is your gross income? (gross income is the individual's total pay from his or her employer before taxes or other deductions)
Do you have a credit score? If so, what is it?
Have you ever filed for bankruptcy? If so , under what chapter, if known?
What is your household size?
Do you and your family members have health insurance?
If no, have you ever had it?

Yes No
If no, do you plan on getting it?

Yes No No sure yet
Do you have a university , school or trade degree?
Do you have any professional certifications?
Please list the languages that you are proficient in reading and writing.
Conclusion
How did you hear about the law firm? *
Name of person/attorney that referred you?
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?

Yes No, thank you.
Overall goal of consult/ what is the main issue that needs to be resolved during consult? *
Should be Empty:

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Please fill out the form as to the best of your knowledge

Applicant/Immigrant's Information

Petitioner's Information

Background Information

Entries and Exits

Legal History (from immigrant's point of view)

Previous Relationships

Family

Affidavit of Support (I-864 Form)

Victim of abuse or crime/asylee/refugee

Conclusion