Immigration
Intake Form

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Immigration Intake Form

Today’s Date

Name

First Middle Last

Nickname/ Maiden Name

Address

Street Address City State / Province / Region ZIP / Postal Code

Phone Number

Cell

Other

E-mail Address

Date of Birth

Town or City of Birth

Country of Birth

Marital Status

Spouse’s Name

Have you or your spouse ever been in divorce proceedings?

Is your spouse or immediate family member a U.S. Citizen or a Permanent Resident (Green Card Holder)? If yes, which family member(s)?

Number of Children for both you and your spouse

Are you or your U.S. Citizen Spouse/Child/Parent a member of the U.S. military or a U.S. military veteran?

Date and place of your most recent entry to the United States

Immigration status at your most recent entry to the United States

Current immigration status

Have you EVER entered the United States illegally? If so, how many times?

Are you currently or have you ever been deported, removed or detained by I.C.E.?

Have you EVER overstayed a U.S. visa?

Have you ever filed for any immigration benefit?

Have you had, or do you currently have DACA?

Have you ever had a J1 visa?

Have you ever been refused or denied a U.S. visa or entry into the U.S.?

Have you ever claimed to be a U.S. citizen OR registered to vote in the U.S.?

Have you ever been the victim of a crime in the United States? If so, what crime?

Have you ever come into contact with or been stopped by law enforcement, given a ticket/citation, been arrested, or anything similar? (Police, I.C.E., Border Patrol, Sheriffs, etc.)

If yes, were you arrested, charged, or given a ticket/citation?

PRIOR CRIMINAL HISTORY

Month/Year

County/ State

Month/Year

Charged With

Month/Year

County/ State

Month/Year

Charged With

Month/Year

County/ State

Month/Year

Charged With

Are you currently on probation or parole?

County/ State

Are there pending charges against you anywhere at this time?

How were you referred to our office?

Reason you are here today

I acknowledge that the information I have provided on this form is correct and true. I also acknowledge that if I hire Christopher Colavecchio, immigration attorney, I will likely have to pay filing fees for my case which do not go The Law Offices of Colavecchio & Colavecchio, PLLC. These filing fees will be paid in addition to the attorney’s fees to USCIS, U.S. Department of Homeland Security, National Visa Center, or another office, and will be made in the form of a check, cashier’s check, or money order, which will be given to The Law Offices of Colavecchio & Colavecchio, PLLC, to be submitted with my immigration paperwork.

Signature

Date

Attorney’s Notes:

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Immigration
Intake Form

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Immigration Intake Form

PRIOR CRIMINAL HISTORY

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