Questionnaire

I. Biographic Information

First Name*

Last Name*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

Phone*

Skype

Date of birth*

Country of birth*

Citizenship*

Citizenship 2

Civil Status:*

Single
Married
Separated
Divorced

Current Immigration Status

Date of Last Entry to the U.S.*

Type of Visa when you Last entered the U.S.

Until what date were you admitted to the U.S.*

Have you ever been placed in deportation or other immigration proceedings?*

Have you ever applied for a U.S. Immigrant Visa (Green Card) before?*

Have you ever applied for ANY U.S. nonimmigrant visa other than the current one?*

If yes, which type of visa?

What was the outcome of this Visa application?

If denied, please explain why:

Alien Number (if applicable)

Have you ever been convicted of any crime or your immediate family members?

II. Immediate Relatives

Please provide information for your immediate family members dependents in the fields below

Do you have any U.S. citizen immediate relatives (Spouse, Parent, or Son/Daughter over age 21)?*

Name of spouse

Place of birth

Date of birth

Citizenship

2nd Citizenship

How many children do you have?

Name of first child

Place of birth

Date of birth

Nationality 1st child

Name of second child

Place of birth

Date of birth

Nationality 2nd child

Name of third child

Place of birth

Date of birth

Nationality 3rd child

Name of fourth child

Place of birth

Date of birth

Nationality 4th child

III. Education

Highest level of Education Completed/Degree Completed:*

Major/Subject Area:

Date Degree Completed:

IV. Business/ Employer Information

Please complete applicable fields only (business owner or your job information)

Business Owner or Employer

Describe the Type of business:

Describe your position:

Where was your company established:

Date Company established:

Income of company for the last 3 years:

Number of employees:

If you or the company own real estate, please provide value of property:

Provide value of company:

Provide value of company equipment or inventory:

How did you find out about our law firm?*

Please specify:

Certification of information*

I certify that all the information provided above is true and accurate to the best of my knowledge.

I. Biographic Information

II. Immediate Relatives

III. Education

IV. Business/ Employer Information

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