Immigration Intake Form

CONFIDENTIAL CLIENT PRIVILEGED IMMIGRATION INTAKE QUESTIONNAIRE
SECTION 1: INFORMATION ABOUT YOURSELF
Full Legal Name

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Date of Birth

MonthDayYear
Date
Country of Citizenship
A Number
SECTION 2: ENTRIES TO THE UNITES STATES
Date of last entry Into US

MonthDayYear
Date
Place of last entry into U.S
Did you see an immigration officer upon this entry?
What was your immigration status when you entered, if any?
Have you entered the United States previously
If so, how many times
Please list the City & State of Prior Entries:
Did you see an immigration officer on your previous entries?
What was your immigration status when you entered, if any?
SECTION 3: IMMIGRATION STATUS
What is your current immigration status, if any?
Are you a Lawful Permanent Resident (“LPR”) of the U.S.?
If so, what date did you become an LPR?

MonthDayYear
Date
How did you become am LPR?
Have you ever applied for Lawful Permanent Residence in the U.S.?
If yes, please state when, where, and outcome:
Have you ever been on a J visa?
If yes, are you subject to the 2-year home residency requirement?
SECTION 4: FAMILY INFORMATION
Current Marital Status

Other
How many times have you been married (including currently)? If applicable include full name of current spouse, data of marriage, City/State/Country of marriage, current spouse nationality, current spouse's date of birth
Please list all your children's name, date of birth, and country of birth (including adult and stepchildren)
Full Name(s) of Prior Spouse(s)
Date Marriage(s) Ended

MonthDayYear
Date
Reason Marriage(s) Ended
State Marriage(s) Ended
Did a prior spouse ever sponsor you for residence?
If yes, please state when, where, and outcome?
Have you ever sponsored anyone for residence?
If yes, please state when, where, and outcome?
Do you have parents or grandparents who are (were) U.S. citizens?
If yes, please list Full Name, Date of Birth, Country of Citizenship, Relationship to You
SECTION 5: EMPLOYMENT INFORMATION
Are you currently employed?
If Yes, where do you work and what is your job title
If required, do you have an employer who is willing to sponsor you?
If Yes, which employer (Contact Name, Phone Number, Email)?
SECTION 6: OTHER BACKGROUND INFORMATION
Have you ever been arrested, charged, indicted, or convicted for any criminal offense anywhere in the world?
If Yes, please state where, when, for what, and outcome:
Have you ever been a victim of a crime in the U.S.?
If Yes, please state where, when, for what, and outcome:
Have you ever had any kind of contact with the police, immigration officer, or any other law enforcement officer?
If Yes, please state where, when, and what happened
Have you ever been in Immigration Court or Deportation, Exclusion, or Removalproceedings before an Immigration Judge?
If yes, please state time, place, and outcome
Have you ever lied to, made a false statement, misrepresentation, or committed fraud to any U.S. official anywhere?
If yes, please state time, place, and outcome
Have you ever claimed to be a U.S. citizen?
If yes, please state time, place, and outcome
Have you ever been in the US or Foreign Military?
If Yes, what service?
Have you ever been involved in or accused of being associated with any of the following (please check all that apply)
Can you support yourself and your family in the U.S.?
Do you have any significant medical condition?
If Yes, please briefly describe
Do you have a fear of returning to your home country?
If yes, please briefly describe
HOW CAN WE HELP YOU?
Why are you seeking the help of HCS Consultancy Services?
How did you hear about us? Acquaintance
Signature
Date

MonthDayYear
Date
Please provide copies of this questionnaire, all immigration related documents, criminal records, and passports in advance of the consultation to: info@hcs-consultancy.com
Should be Empty:

CONFIDENTIAL CLIENT PRIVILEGED IMMIGRATION INTAKE QUESTIONNAIRE

SECTION 1: INFORMATION ABOUT YOURSELF

SECTION 2: ENTRIES TO THE UNITES STATES

SECTION 3: IMMIGRATION STATUS

SECTION 4: FAMILY INFORMATION

SECTION 5: EMPLOYMENT INFORMATION

SECTION 6: OTHER BACKGROUND INFORMATION

HOW CAN WE HELP YOU?