Client Intake Questionnaire (Immigration)

1. Client Information

• Full legal name (as in passport):
• Other names used (aliases, maiden):
• Date of birth:
• Country of birth:
• Country of citizenship:
• A-Number (if any):
• SSN/Tax ID (if any):
• Residential address:
• Mailing address (if different):
• Primary phone:
• Email:
• Preferred communication method (phone/email/portal/text): Text messaging may not be confidential.

2. Immigration Status and History

• Current status:
  ☐ U.S. citizen
  ☐ Lawful permanent resident
  ☐ Nonimmigrant visa: [TYPE]
  ☐ Undocumented / out of status
  ☐ Pending application/appeal

• Date of last entry to the U.S.:

• Place and manner of entry:
  ☐ Inspected and admitted
  ☐ Paroled
  ☐ Entered without inspection

• I-94 number (if any):

• Prior entries and exits (dates and locations):
• Prior immigration filings (I-130, I-485, I-589, etc.):

3. Matter Type

Select all that apply:
☐ Family-based petition
☐ Employment-based petition
☐ Adjustment of status
☐ Consular processing
☐ Naturalization / citizenship
☐ Asylum / withholding / CAT
☐ Removal defense
☐ DACA / TPS
☐ U-visa / VAWA / SIJ
☐ Waiver (I-601 / I-601A / I-212)
☐ Other: ________________________

4. Family Information

• Spouse name, DOB, citizenship/immigration status:
• Children (names, DOB, status):
• Parents (names, status, residence):
• Prior marriages/divorces (dates and documents):

5. Employment and Education

• Employer and job title:
• Work authorization status:
• Highest education level:
• Professional licenses or credentials:

6. Criminal and Immigration Violations

• Arrests, citations, or convictions? ☐ Yes ☐ No
• If yes, list dates, charges, and outcomes:
• Prior removals, deportations, or voluntary departures? ☐ Yes ☐ No
• Prior visa overstays or unlawful presence periods:
• Prior fraud/misrepresentation findings:

7. Travel and Residency

• Current residence length:
• International travel in past 5 years:
• Prior residences (last 5 years):

8. Supporting Documents

☐ Passport and visa
☐ I-94 record
☐ Prior USCIS approvals/denials
☐ Birth certificate
☐ Marriage certificate/divorce decrees
☐ Criminal records/court dispositions
☐ Employment records/pay stubs
☐ Tax returns
☐ Medical records (if applicable)
☐ Other: ________________________

9. Objectives and Deadlines

• Desired outcome:
• Upcoming deadlines/hearings/interviews:
• Urgency or humanitarian factors:

10. Acknowledgment

• I certify that the information provided is accurate to the best of my knowledge and understand that submission does not create an attorney-client relationship until a written engagement agreement is signed.

Client signature: ____________________________ Date: __________

Intake received by (staff): ____________________ Date: __________