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.
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?

YesNo
What was your immigration status when you entered, if any?
Have you entered the United States previously

YesNo
If so, how many times
Please list the City & State of Prior Entries:
Did you see an immigration officer on your previous entries?

YesNo
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.?

YesNo
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.?

YesNo
If yes, please state when, where, and outcome:
Have you ever been on a J visa?

YesNo
If yes, are you subject to the 2-year home residency requirement?

YesNo
SECTION 4: FAMILY INFORMATION
Current Marital Status

SingleMarriedSeparatedWidowedOther
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?

YesNo
If yes, please state when, where, and outcome?
Have you ever sponsored anyone for residence?

YesNo
If yes, please state when, where, and outcome?
Do you have parents or grandparents who are (were) U.S. citizens?

YesNo
If yes, please list Full Name, Date of Birth, Country of Citizenship, Relationship to You
SECTION 5: EMPLOYMENT INFORMATION
Are you currently employed?

YesNo
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?

YesNo
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?

YesNo
If Yes, please state where, when, for what, and outcome:
Have you ever been a victim of a crime in the U.S.?

YesNo
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?

YesNo
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?

YesNo
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?

YesNo
If yes, please state time, place, and outcome
Have you ever claimed to be a U.S. citizen?

YesNo
If yes, please state time, place, and outcome
Have you ever been in the US or Foreign Military?

YesNo
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)

DrugsIllegal GamblingSmugglingTerrorismPolygamyPersecution of OthersGangsCommunismEspionage
Can you support yourself and your family in the U.S.?

YesNo
Do you have any significant medical condition?

YesNo
If Yes, please briefly describe
Do you have a fear of returning to your home country?

YesNo
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*

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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?