G. L. Grobsmith, LLC - IMMIGRATION ASSISTANCE Immigration Client Intake Form
This form collects information for immigration document preparation and assistance. We do not provide legal advice or legal representation.
SECTION 1: BASIC CLIENT INFORMATION
Full Legal Name (First, Middle, Last)
*
First Name
Middle Name
Last Name
Preferred Name (if different)
Date of Birth
*
-
Month
-
Day
Year
Date
Country of Birth
*
Please Select
Afghanistan
Albania
Algeria
United States
Mexico
Canada
India
China
Other
Country of Citizenship
*
Please Select
Afghanistan
Albania
Algeria
United States
Mexico
Canada
India
China
Other
Gender (Optional)
Please Select
Female
Male
Non-binary
Prefer not to say
Other
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Current Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Preferred Language
*
English
Spanish
Other (please specify)
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SECTION 2: IMMIGRATION STATUS
Current Immigration Status
*
U.S. Citizen
Lawful Permanent Resident (Green Card Holder)
Visa Holder
No Current Status
Unsure
If you have a status, select type (if known)
Please Select
B-1/B-2
F-1
H-2A
H-2B
TPS
DACA
Asylum Pending
Other / Not Sure
I entered the U.S.:
*
With a visa
Without inspection
I am outside the U.S.
Date of last entry to the U.S. (if applicable)
-
Month
-
Day
Year
Date
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SECTION 3: SERVICE REQUEST
What service are you requesting? (Check all that apply)
*
Work Permit (I-765)
Renewal of Work Permit
Green Card Application
Family Petition
Visa Application
Adjustment of Status
Change/Extension of Status
TPS
Asylum Support Documents
Citizenship / Naturalization
Document Translation
General Immigration Assistance
Not Sure / Need Guidance
Is this a NEW application or a RENEWAL?
*
New
Renewal
Not Sure
Is there anything else you would like us to know about your case?
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SECTION 4: PRIOR IMMIGRATION HISTORY
Have you ever applied for any U.S. immigration benefit before?
*
Yes
No
Not Sure
Have you ever been denied an immigration application?
*
Yes
No
Not Sure
Have you ever received a Notice to Appear (immigration court)?
*
Yes
No
Not Sure
Have you ever been deported or removed from the U.S.?
*
Yes
No
Not Sure
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SECTION 5: FAMILY & EMPLOYMENT
Marital Status
*
Single
Married
Divorced
Widowed
Do you have immediate family who are:
*
U.S. Citizens
Green Card Holders
No Immediate Relatives in U.S.
Are you currently employed?
*
Yes
No
Self-Employed
Employer Name (if applicable)
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SECTION 6: DOCUMENTS (UPLOAD)
Please upload any documents you already have (if available):(Passport, Visa, I-94, Previous USCIS notices, Work permit, Green card, Birth certificate, Marriage certificate, etc.)
Upload a File
Drag and drop files here
Choose a file
Cancel
of
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SECTION 7: IMPORTANT DISCLOSURES
Legal Disclaimer (Required)
*
I understand that G. L. Grobsmith LLC is not a law firm and does not provide legal advice.
I understand that services provided are limited to immigration document preparation and assistance.
Accuracy Statement (Required)
*
I certify that all information provided is true and correct to the best of my knowledge.
Consent to Contact (Required)
*
I consent to be contacted by phone, email, or text regarding my case.
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SECTION 8: SIGNATURE
Electronic Signature (Type your full name)
*
Date
*
-
Month
-
Day
Year
Date
How did you hear about us?
Referral
Google
Social Media
Community Event
Other
Submit
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