Indo-American Center
DACA Renewal
Applicant's Contact Details
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Date of Birth
Date Your Work Permit Expires
-
Month
-
Day
Year
Date
Have you left the country since obtaining DACA?
Yes
No
Please detail any travel and whether Advance Parole was used.
ELIGIBILITY QUESTIONS
Are you a resident of Illinois?
Yes
No
Have you previously been denied DACA?
Yes
No
Have you ever been STOPPED or ARRESTED by the police in the U.S. or any other country?
Yes
No
Have you ever spent any time (even a few hours) in JAIL or PRISON in the U.S. or any other country?
Yes
No
Have you ever been CHARGED with a CRIME in the U.S. or in any other country?
Yes
No
Have you ever been FOUND GUILTY of any OFFENSE in the U.S. or any other country?
Yes
No
Has your RECORD ever been EXPUNGED (ERASED or WIPED CLEAN)?
Yes
No
Have you ever used false documents or provided false information to an immigration or consulate agent?
Yes
No
Have you ever been STOPPED, DETAINED, or ARRESTED by an IMMIGRATION official?
Yes
No
Have you ever seen an IMMIGRATION JUDGE or received DOCUMENTS regarding immigration court?
Yes
No
Have you ever been deported, removed or turned back around while seeking to enter the US?
Yes
No
Have you ever been in a gang?
Yes
No
If you answer YES on any of the questions in the STOP section, please detail.
Communication Preferences (Language and Computer Competency)
Are you comfortable communicating with the legal team in English on your own or with the help of a family member or friend?
Yes
No
If applicable, please specify the family member/friend and provide contact details:
Which languages are you comfortable communicating in?
Are you comfortable scanning documents and emailing or faxing them to IAC on your own or with the help of a family member or friend?
Yes
No
If applicable, please specify the family member/friend and provide contact details:
Are you comfortable entering data directly online on their own or with the help of a family member or friend?
Yes
No
If applicable, please specify the family member/friend and provide contact details:
What is your preferred method of intake and case communication?
Email
Phone
Video Chat
In Person
Demographics
Country of Birth
Ethnicity
Race
American Indian/Alaska Native
Asian
White
Black
Latino
Middle-Eastern/North African
Highest Level of Education
Marital Status
Single
Married
Divorced
Widowed
If married, nationality of spouse.
For all children, list their name, age, marital status and immigration status.
Document Required
Do you have a copy of the most recent EAD and DACA Approval Notice (front and back) and Advance Parole?
Yes
No
Do you have a copy your driver's license?
Yes
No
Do you have a copy of your most recent tax return (including W-2)?
Yes
No
Do you have a copy of your passport?
Yes
No
Do you have a copy of your prior DACA application?
Yes
No
Please attach all relevant files here.
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Case Worker Who Completed Initial Application
Date Completed
-
Month
-
Day
Year
Date
Submit
Should be Empty: