U.S. Immigration Consultation Data Form
First Name:
Middle Name:
Last Name:
A Number:
Date of Birth:
Contact number:
Home:
Cell:
Work:
E-mail address:
Address:
Last Address:
Current Employer:
Last Employer:
Nationality:
Type of Immigration Matter:
If your matter is not listed, please describe your Immigration matter - 500 word maximum to allow:
Have you ever been in removal, exclusion proceedings?
If yes when and the outcome- 500 words:
Did you legally reenter the country after your removal?
Have you ever obtained a voluntary departure?
If Yes, when?
Do you have a pending appeal with the Board of Immigration Appeal (BIA)?
Do you have a pending appeal at the 9th Circuit Court of Appeals?
Have you been detained by the Immigration and Customs enforcement (ICE)?
Have you stayed outside of the country for more than 1 year?
Do you seek asylum in the U.S.?
Have you ever sought refugee status in Canada?
 
Have you ever been charged or convicted of any crimes in any country?
 
What is your current status in the U.S.?     
If outside of U.S. what is your citizenship?
Date of last entry into the U.S. and name the Port of entry.
Have you ever violated your visa status in the U.S?