Family Based Questionnaire

1

Are you the spouse, widow, unmarried child under the age of 21, or parent of a U.S. citizen who is at least 21 years old?* This field is required.

YESNO

2

Are you an Unmarried son or daughter of a U.S. citizen or Lawful Permanent Resident and you are 21 years old or older, a Married son or daughter of a U.S. citizen, or Brother or sister of a U.S. citizen who is at least 21 years old?

YESNO

3

Do you currently live INSIDE the United States?* This field is required.

YESNO

4

Did you enter the country LEGALLY through a valid visa?* This field is required.

YESNO

5

Do you have a 245(i) filed after January 14, 1998 and on or before April 30, 2001?

YESNO

6

Have you been detained, removed, or deported by the Department of Homeland Security OR convicted of a felony or serious misdemeanor?* This field is required.

YESNO

7

Name* This field is required.

First Name

Last Name

8

Phone Number* This field is required.

Area Code

Phone Number

9

Email* This field is required.

example@example.com