• Basic Information

  • Attorney Employer*

  • Client Date of Birth
     / /
  • Does the client speak English?

  • Criminal History

  • Current Criminal Charges

  • Client Immigration Status

  • What is the client's current immigration status?*
  • What type of temporary visa was granted?

  • U.S. Entry Information

  • Did the client depart/reenter one or more times?*

  • Immigration Applications

  • Has the client previously applied for immigration benefit?
  • Does the client have any current applications?

  • Removals

  • Has the client ever been removed from the U.S.?*

  • Voluntary Departure(s)

  • Was the client ever granted voluntary departure?*

  • Immigration Court

  • Does the client have a current case in immigration court?*
  • Has the client ever had a case in immigration court?*

  • Immigration Relief Screening

  • Does the client have any family members who are U.S. Citizens (USCs) or Legal Permanent Resident (LPRs)?*
  • Check all that apply:
  • Is the client afraid to return to their country of origin?*
  • Has the client ever been the victim of a crime in the United States?*
  • Did the client report the crime(s) and provide assistance to law enforcement investigation(s)?
  • Has the client ever been a victim of domestic violence?*
  • Is the perpetrator a USC or LPR?
  • Is the client under 21 years old and unmarried?*
  • Has the client ever been abused, abandoned, or neglected by a parent?

  • Submit

  • Would you like to provide any further information? (Client in custody, imminent court date, etc.)
  • Should be Empty: