Client intake form Personal InformationName *Email Address *Confirm Email Address *Phone *Street Address *Apartment, suite, etcCityState/ProvinceZIP / Postal CodeA NumberEnter your 9 digit A# from your NTA or EAD card.Date of Birth *MonthSelect month123456789101112DaySelect day12345678910111213141516171819202122232425262728293031YearSelect Year20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Country of Birth *The name of the country where you were born or where you last lived as a citizen.0 / 59Entry to the United States *If you don't know the date then estimate as close as possible.BackgroundEmploymentGeneral employment info.Company Name0 / 70Employment PeriodCompany NameEmployment PeriodApproximate Income *Please provide your approximate annual income from last year or estimated income for this year. .Marital Status *Please select an optionMarriedSingleDivorcedSeparatedWidowedotherSpouse's NameSpouse or ex-spouse's name.Number of ChildrenTotal number of children.Are any of your children US citizens?YesNoUnsureHearing/Interview DateDate of your next hearing or USCIS interviewMonthSelect month123456789101112DaySelect day12345678910111213141516171819202122232425262728293031YearSelect Year2050204920482047204620452044204320422041204020392038203720362035203420332032203120302029202820272026Hearing/Interview TimeTime of your hearing/interviewHoursMinutesAM/PMAMPMDocument UploadDo you have a copy of your immigration file or important documents from immigration that we need to review.Drag and Drop (or) Choose FilesCheck all that apply to you *I have entered the United States more than once.I have been arrested in the United States (for any reason).I have been in removal proceedings in the past or have have been deported in the past.I have been convicted of a crime.I was the victim of a crime in the United States.I am or was married to a US citizen.None of these apply to meHow would you rate this form? *1 star is the worst and 5 stars is best. Was it very difficult to complete or easy to complete?012345Consent *You confirm that the information provided is true and accurate. You confirm that you have read and have complied with the Terms of Use and Privacy Policy. Apply
