Canadian Immigration Law Consultation Form
Name:
Last:   First:   Middle:  
Other names used (including maiden name):
Sex:
E-mail address:
Current Address in U.S.
Number and Street:
City:
State:   Zip:  
Last Address Outside of U.S.
Number and Street:
City:
State/Province:  Postal Code: 
Country:
Home Phone: Hours we can call:
Work Phone: Hours we can call:
Fax Number: Pager/Cell Phone:
Social Security No (if any): Citizen of:
 
Date and Place of Birth:
Date of Birth:
 
City or Town:
State or Province:
Country:
Passport Information:
Passport Country:
Passport Number:
Expiration Date:
 
   
 
What type of immigration assistance are you seeking?
   
FAMILY INFORMATION
Husband or Wife
In the U.S. Outside of U.S. Unmarried
Spouse's Name
Last: First: Middle:
Other names used (including maiden name):
Current Address (put "same" if you live together):
   
Date and Place of Birth: Social Security Number (if any):
Date and Place of Marriage: Alien ("A") Number:
Citizen of: Immigration Status:
Applying with you? Expiration Date:
Children
Total Number of Sons and Daughters:      
Parents
  Name Country of Birth Citizen of Immigration Status
Your Father:
Your Mother*:
Spouse's Father:
Spouse's Mother*:
* Use Mother's Maiden Name
 
Previous Marriages ( Check if Not Applicable)
  Name Date of Marriage Country of Marriage Kids? Reason for Termination of Marriage Date of Termination of Marriage Country of Termination of Marriage
Your's:
 
Spouse's:
 
IMMIGRATION HISTORY
Current Immigration Status: Date Status Expires: Alien ("A") Number:
Date of First Entry into U.S.: Last Entry into U.S.: I-94 Number:
Check every type of immigration status that you have ever held and provide the dates:
  B Visitor:   E Trader/Investor:
  F Student:   H-IP Professional:
  J Exchange Visitor:   K Fiancee:
  L Manager:   O Outstanding Ability:
  T/N Canadian Worker:   Other:  
Check each one that you or your spouse have ever applied for or been the beneficiary of:
Y(you) or S(Spouse)   Date Filed Sponsor Attorney Result
Green Card
Immigrant petition
Labor certification
Asylum  
Amnesty  
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:
EDUCATIONAL BACKGROUND
Please list all your education anywhere in the world:
Level School/Country Degree & Major Number of Years Graduate?
College/University:
College/University:
Other Schooling:
OTHER INFORMATION
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?  
 
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?  
 
Have you ever been denied a visa to come to the United States?  
 
During what years, if any, have you filed an Income Tax Return with the IRS?
 
If you ever had an Employment Authorization Card issued by the INS, give number(s) and validity dates:
 
Is there anything, not already covered in this form, that you feel we should know?
STATEMENT OF TRUTHFULNESS
"By pressing the Send Questionnaire button below, I certify that all of the information contained in this form is true and correct to the best of my knowledge."

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