Do you give consent to contact by email?
Place of Birth (City, State & Country)*:
Where have you lived the last 5 years:
Where have you worked the last 5 years:
All trips taken outside the U.S. the last 5 years:
U.S. IMMIGRATION HISTORY & CURRENT STATUS::
Are you currently present inside the U.S.*:
If yes, how many times have you entered the U.S.?
Have you ever remained in the U.S. past the date of your authorized stay?
Type of visa used on last entry:
Were you inspected (with passport, visa, etc.) on your last entry to the US? *
Have you ever been arrested, charged or cited in the U.S.A. or in any foreign country?*:
If so, how many times? For each arrest, please explain the details
Have you ever been in the deportation process? *
If yes, please explain (in which court, etc.):
Are you afraid to return to your country?*
Have you ever been a victim of a crime in the United States (including domestic abuse)?*
Has any immigration petition or application been filed on your behalf - either by you or someone else?
If yes, please detail what type of petition(s), the date(s) filed, and where filed:
Highest Level of Education:
Are you legally married? *
Nationality of Spouse:
If he/she was naturalized, date of permanent residence or naturalization:
Immigration Status in the U.S.:
If you have children (including stepchildren), how many?
Are either of your parents a legal permanent resident or U.S. citizen?
Please write down your parents' information. If one or both are deceased, indicate the date of his or her death.
Please name which family member, their relationship to you and their immigration status: