Language
English (US)
Spanish (Latin America)
Indo-American Center
General Immigration Intake
What type of immigration assistance do you seek?
I am a legal permanent resident and would like assistance filing for US citizenship.
I would like to renew my DACA.
I want to sponsor a family member living in Illinois.
I live in Illinois and am undocumented and want to obtain legal status.
Other
If other, please explain.
Have you already consulted with any attorney(s) regarding this case?
Have you already filed any petitions with USCIS? If so, please state what you filed and the result.
PLEASE ANSWER THE FOLLOWING SCREENING QUESTIONS TO FACILITATE A QUICK REPLY FROM INDO-AMERICAN CENTER
Applicant's Contact Details
Name
First Name
Middle Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Nationality
Address
Date of Birth
City of Birth
Country of Birth
Country of Citizenship
Were you born in the US or its territories?
Immigration History
When did you last enter the country? Provide the date.
How did you last enter the country?
On a visa
No papers, but at checkpoint
No inspection
Other
How old were you at the time of entry?
Please detail type of visa you entered on (e.g. green card, B1/B2, F1, etc.)
Why did you first come to the country?
Below, please list all the dates of entry/exit into the country and for each trip, whether you were inspected by an immigration officer, what status you entered on, and if applicable, when the authorized stay expired.
Are you a resident of Illinois?
Yes
No
What specific assistance are you looking for?
Have you ever been ordered removed or deported?
Yes
No
Have you ever been in immigration court or encountered an immigration official?
Yes
No
Have you ever been stopped by an immigration official?
Yes
No
Have you ever used fake or borrowed documents to enter the US?
Yes
No
Have you ever either as an adult or a juvenile had any contact with the police or spoken to a police officer?
Yes
No
Have you ever been detained or taken as a prisoner anywhere in the US or abroad?
Yes
No
Have you ever been in a gang or accused of being associated with a gang?
Yes
No
Have you ever worked using someone else's social security number or a fake social security number?
Yes
No
If yes to any of the above eight questions, please provide details.
Have you ever applied for any immigration benefits before? If yes, please detail and provide the results of the application (approved, denied or pending)
Has anyone ever applied on your behalf before? If yes, please explain.
Were your parents or grandparents US citizens? If yes, please describe.
Additional Eligibility Analysis
Have you or any family member ever been the victim of a crime or domestic abuse?
Yes
No
Please describe.
If so, did you report the crime to the police or help with the investigation?
Yes
No
Please describe.
Did anyone recruit you to work in the US?
Yes
No
Did you feel forced or tricked into working?
Yes
No
Were you required to work for no pay or less pay?
Yes
No
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
Gender
Country of Birth
Ethnicity
Race
American Indian/Alaska Native
Asian
White
Black
Latino
Middle-Eastern/North African
Other
If Other, please specify
Highest Level of Education
Marital Status
Single
Married
Divorced
Widowed
If married, nationality of spouse.
What is the immigration status of your spouse
For spouse and all children, list their name, age, marital status and immigration status.
Have you or any family member served in the US military? If so, please detail.
Have you or any family member filed any immigration petition on your behalf or on behalf of your spouse or parent?
Employment Status
Unemployed
Part-Time
Full-Time
Retired
Student
Provide Employer details, including name and address, job title, salary and start date.
Has any employer in the past ever sponsored you for an immigration benefit? If so, please detail.
How many in your household?
Annual Income
Have you filed taxes in the past 3 years?
Name of Person Who Completed This Form
Date Completed
-
Month
-
Day
Year
Date
STOP. Do Not Write Further. This Is Only For The Attorney.
Screening for A2J or ILSP
A2J
ILSP
Other
If Other, fill in:
Potentially eligible for relief
Family Member Who Could Petition
245(i) - Anything Filed Before 04/30/2001 For You or Parents?
Stateside I-601
Acquired/Derived US citizenship
U/T visa
Asylum
VAWA
SIJS
Military parole-in place
Adjustment of status 245(a)
Adjustment of status 245(i)
Non-LPR cancellation
NACARA (Salvadorans and Guatemalans only)
Other
If Other, fill in:
Red Flags
Immigration History (Starting with the most recent entry)
Entry Date
Place of Entry
Manner of Entry (Visa/EWI/Other)
Date of Departure
Place of Departure
Time in the US
1
2
3
4
5
Potential Problems
Crime-based inadmissibility
Misrepresentation
False claim to US citizenship
Prior removal order
Reinstatement of removal
Unlawful presence
Permanent bar
Inadmissibility and Removal Issues
Grounds (*Inadmissibility) (**Deportation/Removal)
Client's Facts
Possible Waiver
Health Grounds (Communicable disease, Drug Abuse/Addiction, Physical/Mental Disorder, Vaccination) *212(a)(1)(A)
212 (g)
212 (h)
213 (Posting Bond)
212 (a)(9)(B)(v)
212(i)
See 212(d)(11), 237(a)(1)(E)(iii)
237(a)(3)(C)(ii)
No waiver. Possible discretion if < than 18 y.o. 237(a)(3)(D)(i)(ii)
Criminal Offenses *212(a)(2)(A)-(E) /**237(a)(5)
212 (g)
212 (h)
213 (Posting Bond)
212 (a)(9)(B)(v)
212(i)
See 212(d)(11), 237(a)(1)(E)(iii)
237(a)(3)(C)(ii)
No waiver. Possible discretion if < than 18 y.o. 237(a)(3)(D)(i)(ii)
Public Charge *212(a)(4)(A) / **237(a)(5)
212 (g)
212 (h)
213 (Posting Bond)
212 (a)(9)(B)(v)
212(i)
See 212(d)(11), 237(a)(1)(E)(iii)
237(a)(3)(C)(ii)
No waiver. Possible discretion if < than 18 y.o. 237(a)(3)(D)(i)(ii)
Unlawful Presence - 3 year bar if UP of >180 days<1year after 4/97 , 10 year if UP>1 year after 4/97 *212(a)(9)(B)(i)(|)-(||) , Permanent bar after previous immigration violation *212(a)(9)(C)
212 (g)
212 (h)
213 (Posting Bond)
212 (a)(9)(B)(v)
212(i)
See 212(d)(11), 237(a)(1)(E)(iii)
237(a)(3)(C)(ii)
No waiver. Possible discretion if < than 18 y.o. 237(a)(3)(D)(i)(ii)
Visa Fraud or Misrepresentation *212(a)(6)(C)
212 (g)
212 (h)
213 (Posting Bond)
212 (a)(9)(B)(v)
212(i)
See 212(d)(11), 237(a)(1)(E)(iii)
237(a)(3)(C)(ii)
No waiver. Possible discretion if < than 18 y.o. 237(a)(3)(D)(i)(ii)
Alien Smuggling *212(a)(6)(E) *237(a)(1)(E)
212 (g)
212 (h)
213 (Posting Bond)
212 (a)(9)(B)(v)
212(i)
See 212(d)(11), 237(a)(1)(E)(iii)
237(a)(3)(C)(ii)
No waiver. Possible discretion if < than 18 y.o. 237(a)(3)(D)(i)(ii)
Document Fraud **237(a)(3)(C)(i)
212 (g)
212 (h)
213 (Posting Bond)
212 (a)(9)(B)(v)
212(i)
See 212(d)(11), 237(a)(1)(E)(iii)
237(a)(3)(C)(ii)
No waiver. Possible discretion if < than 18 y.o. 237(a)(3)(D)(i)(ii)
Falsely Claiming Citizenship
212 (g)
212 (h)
213 (Posting Bond)
212 (a)(9)(B)(v)
212(i)
See 212(d)(11), 237(a)(1)(E)(iii)
237(a)(3)(C)(ii)
No waiver. Possible discretion if < than 18 y.o. 237(a)(3)(D)(i)(ii)
Notes:
Date of Client/Attorney Meeting
-
Month
-
Day
Year
Date
Submit
Should be Empty: