Intake to Petition Relative

Intake to Petition Relative
Name

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.
Gender
example@example.com
Nationality
example@example.com
Please detail type of visa you entered on (e.g. green card, B1/B2, F1, etc.)
example@example.com
Are you US Citizen or Green Card Holder

CitizenGreen Card
How did you acquired Citizenship

Birth in United StatesNaturalization
Alien Registration Number: blanks . Green Card Category: blank
Demographics
Country and town of Birth
example@example.com
Date of Birth

MonthDayYear
Date
Ethnicity
example@example.com
Race

American Indian/Alaska NativeAsianBlackLatinoMiddle-Eastern/North African
Highest Level of Education
example@example.com
Current Marital Status

Single, Never MarriedMarriedDivorcedWidowedSeparatedAnnulled
How many times have you been married. blanks
Date of Current Marriage(if currently married): Date
Place of your current Marriage: (City/Town) blanks .
State & Country: blank
Employment Status

Full TimePart TimeSelf EmployedRetiredUnemployedStudent
Provide Employer details, including name and address, job title, salary and start date.
Annual Income
example@example.com
I am filling petition for (select one box)

SpouseParentBrother/SisterChild
Nationality of your Beneficiary
example@example.com
Is your Beneficiary currently in USA

YesNo
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?

YesNo
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?

YesNo
Are you comfortable entering data directly online on your own or with the help of a family member or friend?

YesNo
If applicable in above all, please specify the family member/friend and provide contact details:
What is your preferred method of intake and case communication?

PhoneEmailIn Person
Form filled by:

First NameLast Name
Date

MonthDayYear
Date
Should be Empty:

Intake to Petition Relative

Demographics

Communication Preferences (Language and Computer Competency)