ConsultForm

CLIENT INTAKE SHEET

PERSONAL INFORMATION
Last Name:
First Name:
Middle Name:
Sex:	Male Female
Address:
City:
State:
Day Phone:
Mobile Phone:
Email Address:
Place of Birth:
Date of Birth:
Social Security No.:
Alien ("A") Number If Any:
Passport Information:
Passport Country:
Passport Number:
Expiration Date:
Citizen Of:
What immigration assistance do you seek:


FAMILY RELATIONSHIPS
Spouse (if any):
Spouse First Name:
Spouse Last Name:
Spouse Middle Name:
Other Names Used Including Maiden Name:
Spouse Place of Birth:
Spouse Date of Birth:
Spouse Social Security Number:
Spouses Alien ("A") Number If Any:

Previous Marriages, If Any (You):
Name:	Date of Marriage:	Country of Marriage:	Kids?:

Reason for Termination of Marriage	Date of Termination of Marriage	Country of Termination of Marriage:

Name:	Date of Marriage:	Country of Marriage:	Kids?:

Reason for Termination of Marriage	Date of Termination of Marriage	Country of Termination of Marriage:

Previous Marriages, If Any (Your Spouse):
Name:	Date of Marriage:	Country of Marriage:	Kids?:

Reason for Termination of Marriage	Date of Termination of Marriage	Country of Termination of Marriage:

Name:	Date of Marriage:	Country of Marriage:	Kids?:

Reason for Termination of Marriage	Date of Termination of Marriage	Country of Termination of Marriage:

Children (if applicable):
Name:	Sex:	Date/Country of Birth:	Citizen of:

Immigration Status:	Expiration Date:	Applying with You?:

Child 2 (if applicable):
Name:	Sex:	Date/Country of Birth:	Citizen of:

Immigration Status:	Expiration Date:	Applying with You?:

Child 3 (if applicable):
Name:	Sex:	Date/Country of Birth:	Citizen of:

Immigration Status:	Expiration Date:	Applying with You?:

Child 4 (if applicable):
Name:	Sex:	Date/Country of Birth:	Citizen of:

Immigration Status:	Expiration Date:	Applying with You?:

Child 5 (if applicable):
Name:	Sex:	Date/Country of Birth:	Citizen of:

Immigration Status:	Expiration Date:	Applying with You?:

Child 6 (if applicable):
Name:	Sex:	Date/Country of Birth:	Citizen of:

Immigration Status:	Expiration Date:	Applying with You?:

Parent - Your Father
Name:	Country of Birth:	Citizen of:	Immigration Status in U.S.:

Parent - Your Mother
Name:	Country of Birth:	Citizen of:	Immigration Status in U.S.:

Parent - Your Spouse's Father
Name:	Country of Birth:	Citizen of:	Immigration Status in U.S.:

Parent - Your Spouse's Mother
Name:	Country of Birth:	Citizen of:	Immigration Status in U.S.:

Brother and/or Sister 1
Name:	Country of Birth:	Citizen of:	Immigration Status in U.S.:

Brother and/or Sister 2
Name:	Country of Birth:	Citizen of:	Immigration Status in U.S.:

Brother and/or Sister 3
Name:	Country of Birth:	Citizen of:	Immigration Status in U.S.:

Grandfather
Name:	Country of Birth:	Citizen of:	Immigration Status in U.S.:

Grandmother
Name:	Country of Birth:	Citizen of:	Immigration Status in U.S.:

IMMIGRATION HISTORY

1. Current Immigration Status:
2. Date of Last Entry into US:
Manner/Entry:
VISA:
Expiration Date of I-94:
I-94 Extended?:
3. Date of Previoust Entry into US:
Manner/Entry:
VISA:
Expiration Date of I-94:
I-94 Extended?:

5. Check each one that you or your spouse have ever applied for or been the beneficiary of:
You (y) Your Spouse (s)		Date Filed:	Sponsor:	Attorney	Result
	Green Card
	Immigrant Petition
	Labor Certification
	Asylum
	Amnesty

6. Have you or your spouse ever had any immigration problems? In particular, have you or your spouse ever been under removal, deportation, or exclusion proceedings? Please describe in detail:

EDUCATION

Please list all education anywhere in the world:
Level	School/Country	Degree and Major	No. of Years	Graduate?
College/University
College/University
Other Schooling

EMPLOYMENT HISTORY

1. Employment in Last Five Years (anywhere in the world)
Job Title	Employer	Country	Duration

2. List the professional licenses or certifications you possess, from any state or country:

3. List any professional awards you have won:

4. Have you been the subject of any news/magazine/other print articles? If so, please list publications and dates:

OTHER

1. Have you ever been arrested or convicted of a crime anywhere in the world (even if the conviction was expunged or removed from your record) or have you ever had any problems with the police?

If yes, please explain in detail:

2. Have you ever claimed to be a citizen of the United States or have you ever used another name for immigration purposes or for any other reason?

If yes, please explain in detail:

3. Have you ever fraudulently/willfully misrepresented a material fact to procure a visa or entry into the U.S. or other benefit?

If yes, please explain in detail:

4. Have you ever been denied a visa to come to the United States?

If yes, when and what kind of visa:

5. If you ever had an Employment Authorization Card issued by the INS, give number(s) and validity dates:

6. During what years, if any, have you filed an Income Tax Return with the IRS?

7. Do you feel that we should know any other information not covered by this form that we should know?

STATEMENT OF TRUTHFULNESS
I certify that all of the information contained in this form is true and correct to the best of my knowledge.
Type Your Name	Type in Today's Date