Your last level of education?
Do you have legal status in the US? *
How many entries have you made to the US?
"If you do not remember the exact date of entry and / or exit, please respond with an estimate (month and year)"
Are you afraid to return to your country?*
Have you ever received public assistance?
Were you inspected (with passport, visa, etc.) on your last entry to the US? *
Type of visa at the last entry to the US:
Country of your citizenship *:
Have you ever been arrested from the police? *
If yes, how many times were you arrested?
Have you ever been in the deportation process? *
If yes, please explain (in which court, etc.):
Has an immigration petition ever been filed for your benefit?
If yes, please detail what type of request?
Are you legally married? *
If yes, how many times have you been married?
Immigration Status of Spouse in the US:
How many children do you have?
Please write down your parents' information. If one or both are deceased, indicate the date of your death.
Please be advised that I will proceed with the processing of your case based on the information provided in
this data sheet. I assume that the information provided is accurate and complete. If there are any material
changes with respect to the information you have provided on this form while your case is being processed
by my office, it is your responsibility to notify me with respect to these changes. Failure to provide accurate
and updated information may result in delays in processing your case and or denial of immigration benefits
by U.S. Citizenship and Immigration Services.
Thank you. We look forward to assisting you with your case.