General Family-Based Case - Consultation Intake Form

Please fill out the form as to the best of your knowledge

Applicant/Immigrant's Information

Applicant/ Immigrant's

^•First Name:

^•Last Name

Country of Birth:

Legal Status, if any:

^•Applicant's E-mail

^•Phone Number:

Overall goal of consult/ what is the main issue that needs to be resolved during consult?

Applicant's Address

^•Street Address:

Street Address Line 2

^•City:

^•State:

^•Zip Code:

If yes, whom and which type of status do they have?

If yes, when and by whom?

Petitioner's Information

^•Petitioner's First Name:

^•Petitioner's Last Name:

Petitioner's Phone Number

^•Phone Number:

^•Petitioner's Email (needed for contracts)

Petitioner's Address

Street Address:

Street Address Line 2:

City:

State:

Zipcode:

If born abroad, which country?

Background Information

Other:

Date Married

Entries and Exits

Applicant/Immigrant's Last Entry into U.S.

How did you enter?

Applicant's First Entry into U.S.

How did you enter?

If more than two entries, please list all entries to the US

If yes, please explain.

Legal History (from immigrant's point of view)

Have you ever been detained, cited, arrested, or stopped by the police or immigration?

If yes, explain:

Have you or any of your family members ever received public benefits?

SNAP

Temporary Assistance for Needy Families (TANF)

Section 8 Housing

Medicare

Supplemental Security Income

Other

If other, explain:

Previous Relationships

If so, how many times?

Have you ever filed taxes together?

Family

Number of Applicant's children (biological, adopted, step)

Number of Petitioner's children (biological, adopted, step)

Affidavit of Support (I-864 Form)

Who will be the sponsor?

What is the sponsor's relationship to the Applicant?

Other:

If self-employed, does sponsor have a registered business? Does sponsor pay themselves separately from business?

If yes, how many?

Conclusion

Victim of abuse or crime/asylee/refugee

If you are a victim of abuse or crime or are an asylee or refugee, please answer the following questions:

Additional questions for beneficiary (Foreign National)

What is your gross income? (gross income is the individual's total pay from his or her employer before taxes or other deductions)

Do you have a credit score? If so, what is it?

Have you ever filed for bankruptcy? If so , under what chapter, if known?

What is your household size?

Do you and your family members have health insurance?

Do you have a university , school or trade degree?

Do you have any professional certifications?

Please list the languages that you are proficient in reading and writing.

Other:

Name of the person completing the intake sheet:

Name of person/attorney that referred you?

Date:

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