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1345 Avenue of the Americas, 2nd Floor
New York, NY 10105
KEN
.
C. GARCIA
ATTORNEY AT LA
W
_________________________________
Immigration & Nationality Law
FREE CONSULTATION
Fee-Based CONSULTATION Intake Questionnaire
INFORMATION ABOUT THE PERSON COMPLETING THIS QUESTIONNAIRE
*
Indicates required field
1. Complete Name:
*
First
Last
2. Present Address:
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Line 1
Line 2
City
State
Zip Code
Country
3. Home Phone Number:
*
4. Mobile Phone Number:
*
5. Email:
*
6. Type of Fee-Based Consultation Preferred:
*
In-person
Via Telephone
Through Email
7. I am seeking legal advice for:
*
Myself
A Third Party (Relative/Friend)
Please answer all questions completely and truthfully.
If a required field is not applicable, please write N/A or NA.
The information collected will be used to evaluate the client’s situation and options, will be kept entirely confidential and will not be disclosed to anyone without the client’s consent.
This consultation is limited to the specific issue/problem for the client submitting the questionnaire based on existing facts and law. Any new or additional issue/problem with respect to the client by reason of changed circumstances and facts or law would require a new consultation.
This questionnaire is not an agreement for the attorney to represent you. All clients must sign a written contract with the attorney before any representation will begin.
CLIENT’S BIOGRAPHIC INFORMATION
Note:
If you are seekin
g legal advice for yourself, pl
ease complete the questionnaire using your own
information and situation.
If you are seeking legal advice for a friend/relative, please complete the questionnaire using your
friend/relative’s information and situation.
8. Complete Name, if different from above:
*
First
Last
9. Complete Address, if different from above:
*
Line 1
Line 2
City
State
Zip Code
Country
10. Home Phone Number, if different from above:
*
11. Mobile Phone Number, if different from above:
*
12. Email, if different from above:
*
13. Date of Birth (mm/dd/yyyy):
*
14. City & Country of Birth:
*
15. Country of Citizenship:
*
16. Present Civil Status:
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Single
Married
Divorced/Annulled
Widow (er)
16(a). If single, client is engaged to be married to a:
*
U.S. Citizen
Lawful Permanent Resident ("Green Card" Holder)
Nonimmigrant Alien Presently in the U.S.
Not Applicable
16(a)(i). If client is engaged to be married to a U.S. Citizen, when did client last meet and see the U.S. Citizen fiancé(e)?
*
Write "N/A" if not applicable.
16(a)(ii). If client is engaged to be married to a nonimmigrant alien presently in the U.S., specify fiancé(e)s visa classification:
*
Write "N/A" if not applicable.
16(b). If married, please provide the following:
16(b)(i). Complete Name of Present Spouse:
*
First
Last
Write "N/A" if not applicable.
16(b)(ii). Spouse's City of Birth:
*
Write "N/A" if not applicable.
16(b)(iii): Spouse's Country of Citizenship:
*
Write "N/A" if not applicable.
16(b)(iv): Is spouse presently in the U.S.?
*
Yes
No
Not Applicable
16(b)(v). Is spouse a Lawful Permanent Resident?
*
Yes
No
Not Applicable
16(b)(vi). If spouse is neither a US Citizen nor a Permanent Resident, is s/he a holder of a valid nonimmigrant visa/status?
*
Yes
No
Not Applicable
16(b)(vii). If client is married to a nonimmigrant alien presently in the U.S., specify spouse's visa classification:
*
Write "N/A" if not applicable.
16(b)(viii). How many times has client been married?
*
Write "N/A" if not applicable.
17(c). If divorced/annulled, please provide the following:
17(c)(i). Date of divorce/annulment per final order from court:
*
Write "N/A" if not applicable.
17(c)(ii). Place of divorce/annulment (City/Country):
*
Write "N/A" if not applicable.
CLIENT’S ENTRY INFORMATION
18. Client’s date of first entry into the US (mm/dd/yyyy or mm/yyyy):
*
Write "N/A" if not applicable.
18(a): Nonimmigrant visa classification upon first ever entry into the US:
*
Write "N/A" if not applicable.
19. Client's date of most recent entry into the US, if different from above (mm/dd/yyyy or mm/yyyy)
*
Write "N/A" if not applicable.
19(a). Upon client's date of most recent entry into the U.S., client arrived as:
*
B1/B2 Visitor
Visa Waiver Program Visitor
Student (Academic/Vocational)
Temporary Worker
Exchange Visitor
Crewman
"Jump Ship"/Stowaway
Fiance/e
Without Inspection (No Visa)
Other
Not Applicable (client has never entered the US)
19(a)(i). If "Other," please specify:
*
Write "N/A" if not applicable.
20. Client’s current immigration status:
*
Write "N/A" if not applicable.
21. Date authorized stay, whether initial or extended, expired/will expire (mm/dd/yyyy):
*
Write "N/A" if not applicable.
22. Did client enter the US using a fake name?
*
Yes
No
Not Applicable
CLIENT’S EDUCATIONAL BACKGROUND
23. Is client a high school graduate?
*
Yes
No
24. Is client a holder of a 4-year college degree?
*
Yes
No
24(a). If yes, please specify degree/major:
*
Write "N/A" if not applicable.
25. Is client a holder of an advanced degree?
*
Yes
No
25(a): If yes, please specify advanced degree:
*
Write "N/A" if not applicable.
CLIENT’S EMPLOYMENT
BACKGROUND
26. Client’s Present Job Title/Position, if any:
*
Write "N/A" if not applicable.
27. Name of Client’s Present Employer, if any:
*
Write "N/A" if not applicable.
28. If client is present employed, is the employer/company a parent company, branch, subsidiary, affiliate of a US-based company?
*
Yes
No
29. Years of Employment with Present Employer, if applicable:
*
Write "N/A" if not applicable.
30. Client’s Previous Work Experience, if any (specify each job title/position and corresponding period of employment)::
*
Write "N/A" if not applicable.
CLIENT'S MISCELLANEOUS INFORMATION
31. Is client married to a U.S. Citizen?
*
Yes
No
32. Is client an unmarried child below 21 years of age of a U.S. Citizen?
*
Yes
No
33. Is client a parent of a U.S. Citizen who is at least 21 years of age?
*
Yes
No
34. Is client an adopted child of a U.S. Citizen?
*
Yes
No
35. Is client a step-child of a U.S. Citizen?
*
Yes
No
36. Is client an unmarried son/daughter who is 21 years or older of a U.S. Citizen?
*
Yes
No
37. Is client a married son/daughter of a U.S. Citizen?
*
Yes
No
38. Is client a brother/sister of a U.S. Citizen?
*
Yes
No
39. Is client a spouse of a Permanent Resident (“Green Card” holder)?
*
Yes
No
40. Is client an unmarried child below 21 years old of a Permanent Resident?
*
Yes
No
41. Is client an unmarried son/daughter (over 21 years of age) of a Permanent Resident?
*
Yes
No
42. Did client enter the U.S. before January 1, 1972 and reside continuously in the country up to the present?
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Yes
No
43. Did client enter the U.S. before January 1, 1982 and reside continuously in the country up to the present?
*
Yes
No
44. Was client’s mother, father, grandfather or grandmother born in the U.S. or became a naturalized US citizen before the client’s birth?
*
Yes
No
44(a). If yes, please specify the US citizen relative:
*
Mother
Father
Grandparent
Not Applicable
45. Was client in the U.S. as of December 12, 2000?
*
Yes
No
46. Was client in the U.S. as of January 15, 2012?
*
Yes
No
47. Client is a/an:
*
Religious minister
Nun
Rabbi
Priest
Ordained deacon
Monk
Religious instructor
Counselor or catechist
Worker in a religious health care facility
Religious broadcaster
None of the above
48. Client is a:
*
Former employee of a Panama Canal Company or the Canal Zone government
Long-time employee of the U.S. Government Foreign Office
Long-time employee of the U.S. Armed Forces
None of the above
49. Client is a:
*
Retired employee of an international organization
Spouse or child of a G-4 or N visa holder
Spouse of a deceased employee of an international organization
None of the above
50. Client is a:
*
Retired NATO-6 civilian
Spouse or child of an SN-1 visa holder
Spouse of a deceased NATO-6 civilian employee
None of the above
51. Is client a foreign agricultural worker who performed agricultural field labor for at least 90 days between May 1, 1985 and May 1, 1986?
*
Yes
No
52. Is client a foreign medical graduate who came to the U.S. before January 10, 1978 on either an H or J visa and continue to practice medicine?
*
Yes
No
53. Can client provide valuable information about organized crime or terrorism?
*
Yes
No
54. Is client a victim of a crime such as incest, domestic violence, assault, false imprisonment, extortion, obstruction of justice, or sexual assault/abuse, and is or was willing to cooperate in the investigation or prosecution of the crime?
*
Yes
No
55. Is client a victim of trafficking of persons under 18 years of age or trafficking and indentured servitude of persons by use of force or fraud?
*
Yes
No
56. Is client an abused spouse or child of a U.S. Citizen or Lawful Permanent Resident?
*
Yes
No
57. Is client less than 21 years of age who has been declared dependent in a juvenile court located in the U.S.?
*
Yes
No
58. Is client willing to invest $500,000 in a commercial enterprise in a targeted area in the U.S. or willing to invest $1,000,000 in a commercial enterprise in the U.S.?
*
Yes
No
59. Is there a U.S. employer willing to file a petition (sponsor) for the client to work in the U.S.?
*
Yes
No
59(a). If yes, specify position/title offered:
*
Write "N/A" if not applicable.
60. Was a family-based immigrant petition ever filed on behalf of client?
*
Yes
No
60(a): If yes, please specify when the family-based petition was filed (mm/dd/yyyy or mm/yyyy):
*
If you cannot provide the exact date of filing, the approximate year of filing will be sufficient.
60(b). If a family-based petition was filed, please provide the date it was approved, if any (mm/dd/yyyy or mm/yyyy):
*
If you cannot provide the exact date of approval, the approximate year of approval will be sufficient.
60(c). Specify the type of family-based immigrant petition filed on behalf of client:
*
U.S. Citizen filing on behalf of a spouse
U.S. Citizen filing on behalf of a unmarried child
U.S. Citizen filing on behalf of a parent
U.S. Citizen filing on behalf of an unmarried son/daughter
U.S. Citizen filing on behalf of a married son/daughter
U.S. Citizen filing on behalf of a brother or sister
Lawful Permanent Resident ("Green Card" Holder) filing on behalf of a spouse
Lawful Permanent Resident ("Green Card" Holder) filing on behalf of an unmarried child under 21 years of age
Lawful Permanent Resident (("Green Card" Holder) filing on behalf of unmarried son/daughter (21 years of age or older)
Not Applicable
61. Was an employment-based immigrant petition ever filed on behalf of client?
*
Yes
No
61(a). If yes, please specify when the labor certification or employment-based petition, if there was no labor certification required, was filed (mm/dd/yyyy):
*
Write "N/A" if not applicable. If you cannot provide the exact date of filing, the approximate year of filing will be sufficient.
61(b). If an employment-based petition was filed, please provide the date it was approved, if any (mm/dd/yyyy):
*
Write "N/A" if not applicable. If you cannot provide the exact date of approval, the approximate year of approval will be sufficient.
61(c). Specify the type of employment-based immigrant petition:
*
Petition for person with extraordinary ability, outstanding professor and researcher or multinational manager or executive
Petition for person holding an advanced degree or person with exceptional ability
Petition for person holding a 4-year college degree, skilled or unskilled worker
Special Immigrant
Immigrant Investor
Not Applicable
62. Was a family-based or employment-based immigrant petition ever filed on behalf of any of client’s parents while client was under 21 years of age?
*
Yes
No
Do not know
63. Has client ever filed any petition or application with USCIS (or the legacy INS), DOL or any other agency to acquire an immigration benefit?
*
Yes
No
63(a). If yes, please specify the petition/application filed:
*
Write "N/A" if not applicable.
63(b). Status of said petition/application:
*
Write "N/A" if not applicable.
64. Has client ever been placed in removal or deportation proceedings, ordered deported, or failed to attend a deportation hearing?
*
Yes
No
64(a). If yes, please provide details.
*
Write "N/A" if not applicable.
65. Has client ever been arrested, cited, charged, indicted, detained or imprisoned for breaking or violating any law or ordinance (excluding traffic violations)?
*
Yes
No
65(a). If yes, please provide the following:
65(a)(i). Place and Date of Arrest:
*
Write "N/A" if not applicable.
65(a)(ii). Reason for the arrest/citation/charge/indictment/detention:
*
Write "N/A" if not applicable.
65(a)(iii). Outcome of the arrest/citation/charge/indictment/detention:
*
Write "N/A" if not applicable.
66. Is client unwilling to return to his/her country because of persecution or a well- founded fear of persecution on account of race, religion, nationality, membership in a particular social group or political opinion?
*
Yes
No
66(a). If yes, please provide details.
*
Write "N/A" if not applicable.
67. Does client have any upcoming deadline to appear before any immigration- related body and/or submit requirements before the USCIS, NVC or immigration court?
*
Yes
No
67(a). If yes, please provide details.
*
Write "N/A" if not applicable.
68. How can I help you? Please describe in detail the nature of the immigration issue/concern and the type of legal assistance being sought.
*
Submit