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1345 Avenue of the Americas, 2nd Floor
New York, NY 10105
ken
garcia
attorney at law
_________________________________
Immigration & Nationality Law
FREE CONSULTATION
EXTENSION/CHANGE OF STATUS APPLICATION
QUESTIONNAIRE
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 prepare the applicable petition/application, will be kept entirely confidential and will not be disclosed to anyone without the client’s consent.
INFORMATION ABOUT THE APPLICANT
1. Complete Name (LAST, First, Middle):
*
2. Present Address:
*
Line 1
Line 2
City
State
Zip Code
Country
3. Daytime Phone Number:
*
4. Mobile Phone Number:
*
5. Email:
*
6. Date of Birth (mm/dd/yyyy):
*
7. City of Birth:
*
8. Country of Birth:
*
9. A-Number, if any:
*
Write "N/A" if not applicable.
10. U.S. Social Security Number, if any:
*
Write "N/A" if not applicable.
11. Date of Last Arrival Into the U.S. (mm/dd/yyyy or mm/yyyy):
*
Write "N/A" if not applicable.
12. I-94 Number:
*
Write "N/A" if not applicable.
13. Current Nonimmigrant Status:
*
Write "N/A" if not applicable.
14. Expiration Date of the Nonimmigrant Status (mm/dd/yyyy):
*
15. Cities Visited Since Most Recent Arrival into the U.S.:
*
16. Purpose of the Application:
*
An extension of stay in my current status
A change of status
16(a). For an extension of stay, indicate number of months to be requested:
*
About 2 months
About 4 months
About 6 months
116(b). For a change of status, specify the new status to be requested:
*
If you cannot provide the exact date of filing, the approximate year of filing will be sufficient.
17. Passport Information:
17(a). Passport Number:
*
17(b). Country of Issuance:
*
17(c). Passport Expiration Date (mm/dd/yyyy):
*
18. Complete Address Abroad:
*
Line 1
Line 2
City
State
Zip Code
Country
19. Are you, or any other person included on the application, an applicant for an immigrant visa?
*
Yes
No
20. Has an immigrant petition ever been filed for you or any other person included in this application?
*
Yes
No
21. Has Form I-485, Application to Register Permanent Residence or Adjust Status, ever been filed by you or by any other person included in this application?
*
Yes
No
22. Have you, or any person included in the application, ever been arrested or convicted of any criminal offense since last entering the United States?
*
Yes
No
22(a). If yes, describe the circumstances of the arrest/conviction in detail:
*
23. Are you, or any other person included in the application, now in removal proceedings?
*
Yes
No
Submit