Production - JDC AOD Intake Form

  • JDC AOD Intake Form

  • Intake Date
     - -
  • Docket
  • MCH #
  • Birthdate*
     - -
  • Format: (000) 000-0000.
  • Disabled
  • Veteran?
  • Do you or does your child attend an SFUSD school?
  • Pro Se Assistance Needed
  • Qualifies for
  • Asylum application filed?
  • Date Filed?
     - -
  • Advisal's and info provided to respondent
  • Next Hearing:
  • Next Hearing Date/Time
     - -

  • FOLLOW-UP

  • Attorney Search

  • Contacted Attorneys?
  • Submitted docs to Court/ filed application/lodged asylum app?
  • Pleadings already taken?
  • Applications pending before other agencies?
  • Has Government Submitted Docs?
  • Date Motion or Doc Was Filed
     - -
  • Date Response is Due
     - -

  • IMM. HISTORY

  • First Entry Date
     - -
  • First Entry Date Actions
  • Last Entry Date
     - -
  • Last Entry Date Actions
  • NTA Service Date
     - -
  • TYPE
  • Date Admitted
     - -
  • Placement in Proceedings by:
  • Did you use the CBP One App prior to entering the U.S.?

  • If No, and entered the U.S. after 5/11/23, then advise pro se about the CLP Rule.
    If Yes, check if has I-94, when it expires, and if still valid, advise pro se about auto-eligibility for EAD.

  • Entered with family member?
  • Consolidation of family members’ cases needed?
  • Absences from the U.S.?
  • Prior Immigration Contacts?

  • Criminal History

  • Have you ever been arrested by the police here in the U.S. or in your home country?
  • ARREST / CHARGE (Offense)
  • ARREST / CHARGE (Offense)
  • ARREST / CHARGE (Offense)

  • Family

  • Spouse:

  • Riders

  • Date of Birth
     - -
  • Date of Birth
     - -
  • Date of Birth
     - -
  • Date of Birth
     - -
  • Date of Birth
     - -

  • Children

  • Parents

  • Parent Status

  • Grandparents

  • Grandparent Status

  • Siblings

  • Sibling Status

  • Immigrant Petitions

  • Any Immigrant Petitions Filed for you? (Or for your spouse or parent)
  • Date Filed
     - -

  • U-Visa:

  • Have you/spouse/child/child’s sibling been a VICTIM of CRIME or DV in the US?
  • If Yes, was it reported?
  • Has copy of police report?
  • Was Perpetrator found and charged?

  • Asylum/CAT/Withholding:

  • Fear of Return?
  • Fear based on

  • Informed: I understand that it’s difficult to talk about traumatic events. However, you should know that if someone in your household physically, emotionally, or sexually harmed you, it could be a basis for asylum. Also if severely discriminated against or harmed because of LGBT status.

  • SIJS

  • Eligible?
  • Do you live with your mother?
  • Does she support you financially?
  • Do you live with your father?
  • Does he support you financially?
  • Are you in contact with your parents?

  • T-Visa Eligibility

  • Did the people who helped you to enter the U.S. trick, pressure, intimidate, or scare you into to do something you were not comfortable doing? (i.e. carry something across a border)
  • In the U.S. has anyone ever tricked, pressured, or intimidated you into doing something you were not comfortable doing, or forced you to work against your will?
  • ALL RELIEF IDENTIFIED

  • TPS Eligible? Check USCIS webpage for more information if pro se if from one of the following:

    Afghanistan Ethiopia Nicaragua South Sudan
    Burma Haiti Syria Ukraine
    Cameroon Honduras Somalia Venezuela
    El Salvador Nepal Sudan Yemen

  • Eligible for Deferred Action based on Labor Violation?

  • If 18 years or older:

  • Are you working?
  • Has your employer paid you for all of the hours that you have worked?
  • Were you ever sexually abused or harassed at work?
  • Did you ever have to work in a condition that you felt was unsafe?

  • If under 18 years of age:

  • Do you go to school?
  • Are you also working?
  • Have you ever been injured at work?
  • Should be Empty: