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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
VAWA QUESTIONNAIRE
P
lease 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 your eligibility to file an immigrant petition under the Immigration and Nationality Act (INA), as amended by the Violence Against Women Act (VAWA), will be kept entirely confidential and will not be disclosed to anyone without the client’s consent.
PART I. PERSONAL INFORMATION
1. Complete Name (LAST, First, Middle):
*
2. Present Address:
*
Line 1
Line 2
City
State
Zip Code
Country
3. Mobile Phone Number:
*
4. Email:
*
5. Date of Birth (mm/dd/yyyy):
*
6. City of Birth:
*
7. Country of Birth:
*
8. Country of Citizenship:
*
9. Sex:
*
Male
Female
10. Civil Status:
*
Single
Married
Separated
DIvorced
Widowed
Marriage Annulled
11. Check all that apply:
*
I am married to a U.S. Citizen or Lawful Permanent Resident
My marriage my U.S. Citizen or Lawful Permanent Resident spouse was terminated by death or divorce within 2 years prior completing this form
My spouse lost or renounced citizenship or permanent resident status within 2 years prior completing this form
I believe that I was legally married to my U.S. Citizen or Lawful Permanent Resident spouse but the marriage was not legitimate solely because of my spouse's bigamy
I have been placed in an alternative sentencing or rehabilitative program (e.g. diversion, deferred prosecution, withheld adjudication, deferred adjudication).
I have suffered battery/extreme cruelty by my U.S. Citizen or Lawful Permanent Resident spouse
I have entered into the marriage in good faith, not solely for immigration benefits.
I have resided with my spouse.
I am a person of good moral character.
None of the above is applicable.
12. Check all that apply:
*
I am the child of a U.S. Citizen or Lawful Permanent Resident.
I am a child of a U.S. Citizen or Lawful Permanent Resident. who lost citizenship or Lawful Permanent Resident status due to an incident of domestic violence.
I have suffered battery/extreme cruelty by my U.S. Citizen or Lawful Permanent Resident parent.
I have resided with my abusive parent.
I am a person of good moral character or I am less than 14 years of age.
None of the above is applicable.
13. Check all that apply:
*
I am the parent of a son/daughter who is at least 21 years of age and a U.S. Citizen.
I am a parent of a U.S. Citizen son/daughter who lost or renounced citizenship related to an incident of domestic violence.
I am a parent of a U.S. Citizen son/daughter who was a who was at least 21 years of age and who died within 2 years prior to completing this form.
I have suffered battery/extreme cruelty by my U.S. Citizen son/daughter.
I have resided with the abusive son/daughter.
I am a person of good moral character.
None of the above is applicable.
14. If you suffered battery/extreme cruelty in Nos. 11, 12 or 13, please explain in detail how you were subjected to such act/s by your abusive spouse, parent or son/daughter.
*
Submit