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Note, all information you submit will be kept strictly confidential. However, an attorney-client relationship will only be created when you sign a retainer agreement with our office. Until this retainer agreement has been signed, no one from our office will be considered your attorney or legal representative. By clicking "SUBMIT FORM" at the bottom of this page, you acknowledge that you understand that no attorney-client relationship will be created until you have signed a retainer agreement with our office.
Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Telephone Number
E-mail
Best date(s) and time(s) to contact you. When writing a time, please also indicate WHICH TIME ZONE you are referring to, so that we contact you at the appropriate time.
Date of Birth

Month Day Year
Alien Registration Number (A#), if any
Country/Countries of Citizenship
Marital Status

Single Married Divorced Widowed
If you have a child/children, please write: (1) the child/children's name(s); (2) the child/children's date(s) of birth; and (3) the child/children's country/countries of citizenship
My current immigration status in the U.S. is

Green Card Temporary UNEXPIRED Status (including Tourist, H-1B, L-1, etc.) Entered Legally but Overstayed Entered the USA Illegally TPS Outside USA
I am

not currently in an Immigration Detention Facility currently in an Immigration Detention Facility
My mother is

in the USA as a Lawful Permanent Resident (Green Card Holder) in the USA as a U.S. Citizen outside the USA deceased
My father is

in the USA as a Lawful Permanent Resident (Green Card Holder) in the USA as a U.S. Citizen outside the USA deceased
I filed for a Green Card (including a Labor Certification filed by an employer) on or before April 30, 2001

Yes No
Criminal History (INCLUDING expunged convictions, and DUI/DWI)

I have never been convicted of any crime. I have been convicted of a misdemeanor. I have been convicted of a felony.
Previous Immigration Court History

I have never been in Immigration Court proceedings. I am currently in Immigration Court proceedings for the first time. I have previously been in Immigration Court proceedings.
I am afraid that if I return to my country, someone will hurt me.

Yes. No.
How did you hear about us?

I KNOW a past or current client. I AM a past or current client. Google Yahoo Bing Other search engine Other source
If you heard about us from another source, please specify which source
Optional: please include anything else you would like to tell us to help us assess your case.
Should be Empty:

To help us better assess your case, please fill out the information below, and then click "SUBMIT FORM" on the bottom, and we will contact you within one (1) business day.