AILA's Immigration Practice Toolbox

General Immigration Questionnaire

Date:______

LegalReviewer:______

Refer Out: ______

Need More Documents to Determine:______

BIOGRAPHICAL INFORMATION

Applicant Name ______

A#______Date of LPR______

I. INFORMATION REGARDING APPLICANT

Name: ______

(Last), (First), (Middle)

Other names:____Sex: Male Female

(Includes Maiden, Religious, Professional, Aliases, etc.)

Date of birth:Place of birth:

(Mo/Day/Yr)(City), (State), (Country)

Citizenship:

(Country)

Address:

E-Mail: Telephone: Facsimile:

If in the U.S., complete the following:

Date of arrival: I-94No.:

(Mo/Day/Yr)

Current nonimmigrant status: Expires:

(Mo/Day/Yr)

Place where last entered U.S.:Was it a sea, land or air port of entry? ____

Did you talk with a Customs and Border Protection Agentbefore your entry into U.S.?

PassportNo.: Date issued: Date expires:

(Mo/Day/Yr)(Mo/Day/Yr)

Were any of your or your spouse’s grandparents born in the United States? Yes No

If so, when?

Are either you or your spouse an American Indian born in Canada of at least 50 percent Native bloodline? Yes No

Are either you or your spouse eligible for a Native American tribal document? Yes No

Are either your or your spouse’s parents citizens of the United States? Yes No

If so, when did they obtain citizenship?

II. MARITAL INFORMATION

Marital status:  Married Widowed Divorced Separated  Single

Spouse’s Immigration Status:______

Spouse’s Name:

(Last), (First), (Middle)

Other names used:Sex: Male Female

(Includes Maiden, Religious, Professional, Aliases, etc.)

Date of birth: Place of birth:

(Mo/Day/Yr)(City), (State), (Country)

Citizenship: U.S. Social SecurityNo.

Date of marriage: Place of marriage:

Spouse’s former spouse name / Country of
citizenship / Date of
divorce/death

Is your spouse currently working in the U.S.? Yes No

If yes, does he or she have authorization to work full-time? Yes No

If no, does he or she wish to work in the U.S.? Yes No

Were you previously married? Yes No

Your first former spouse’s name:

(Last), (First), (Middle)

Date of birth: ______Place of birth:______

(Mo/Day/Yr)(City), (State), (Country)

Citizenship: Date of divorce/death: Place of divorce:

Your second former spouse’s name: ______

(Last), (First), (Middle)

Date of birth:______Place of birth:______

(Mo/Day/Yr)(City), (State), (Country)

Citizenship: Date of divorce/death: Place of divorce:

Will this case type require the attorney to represent the spouse? Yes No Unknown at this time______

Note to Intake Attorney—If you are going to represent the spouse, please sent up a separate meeting with the applicant and spouse in person, and let Ann or Renae know so that we can ask CVLS to set up a case for the spouse and run a conflict check.

III. RELATIVES’ INFORMATION

LIST PRESENT BROTHERS, SISTERS AND CHILDREN, INCLUDING STEPCHILDREN

Name
(First, Last) / Relationship / DOB / City/State/
Country of Birth / Applying with you / Immig Status
1.
Address:
2.
Address:
3.
Address:
4.
Address:
5.
Address:
6.
Address:

Do you have any children who are within four years of the age of 21 who may eventually want to live permanently in the U.S.? Yes No

Has anyone ever filed an I-130 petition (note to attorney, you may need to say something along the lines of, “filed papers”) for your spouse, mother or father? Yes No

Has anyone ever filed an I-130 petition for you or your spouse? Yes No If yes, who filed it?______

When was the petition filed?______Do you have copies of the approval notice? Yes No

Were you present in the U.S. on December 21, 2000? Yes No

List any Aunts or Uncles in the U.S, for either you or your spouse, who have U.S. Citizenship:

Name:______Aunt or Uncle? ______

Paternal/Maternal?______Related to you or to spouse:  You  Spouse

Any chance the aunt/uncle filed an I-130 petition (note to attorney, consider saying something like, “filed papers”) for your/your spouse’s parent? Yes No

Name:______Aunt or Uncle? ______

Paternal/Maternal?______Related to you or to spouse:  You  Spouse

Any chance the aunt/uncle filed an I-130 petition (note to attorney, consider saying something like, “filed papers”) for your/your spouse’s parent? Yes No

Name:______Aunt or Uncle? ______

Paternal/Maternal?______Related to you or to spouse:  You  Spouse

Any chance the aunt/uncle filed an I-130 petition (note to attorney, consider saying something like, “filed papers”) for your/your spouse’s parent? Yes No

Name:______Aunt or Uncle? ______

Paternal/Maternal?______Related to you or to spouse:  You  Spouse

Any chance the aunt/uncle filed an I-130 petition (note to attorney, consider saying something like, “filed papers”) for your/your spouse’s parent? Yes No

****Please use notes section at the end for additional aunts/uncles.

IV. INFORMATION REGARDING U.S. EMPLOYER

Company name:

Address:

Type of business:

Position full-time? Yes NoNumber of hours per week:

Wages per week: $Other compensation? Value: $

Company contact:

Telephone: Facsimile:

V. IMMIGRATION AND ADMISSIBILITY RELATED QUESTIONS

Have you ever been placed in immigration proceedings? Yes No

Exclusion Deportation  Rescission Judicial proceedings

Where: When: ______

Have you ever applied for a U.S. nonimmigrant visa before? Yes No

If yes, Classification: ______Where: When:

Outcome?  Issued  Refused

***Please list for all prior visas in the U.S., included changes of extensions of stay obtained while in the U.S.

Has your U.S. visa ever been canceled? Yes No

Have you ever (in or outside the United States) been arrested, cited, charged, indicted, fined or imprisoned for breaking or violating any law or ordinance, even as a juvenile, or if later sealed or expunged?  Yes  No

Have you ever received public assistance, such as TANF, food stamps, or WIC?

If yes, explain:______

(Include the names and Social Security number(s) you used)

Have you ever helped any alien to enter the U.S. illegally, including by paying a smuggler or coyote? If so, who did you help, and when was it?______

Have you ever been a member of the Communist Party?  Yes No If so, when?______

Have you ever been deported from the U.S?  Yes  No

Have you ever been a J nonimmigrant exchange visitor?  Yes  No

Have you ever been the victim of a crime or of criminal activity in the U.S.?  Yes  No

If yes, did you report the crime to law enforcement?  Yes  No

VI. ELIGIBILITY TO NATURALIZE

Is either parent a USC? Yes No

If yes, was the applicant under 18 when parent became a USC? Yes No

Will applicant be able to take the test in English? (ask in English) Yes No

If no, is the applicant eligible for one of the following waivers:
50/20 (age of at least 50 and LPR for 20 years) to take the test in his/her nativelanguage?

 Yes  No

55/15 (age of at least 55 and LPR for 15 years) to take the test in his/her native language?

Yes No

65/20 (age of at least 65 and LPR for 20 years) to take the shorter test in his/her native language? Yes No

If not eligible for any waivers in #1 then does the applicant qualify for an N-648 medical waiver? (Note: The waiver is available to individuals who seek an exception to the English and/or civics requirements due to a physical or developmental disability or mental impairment that has lasted, or is expected to last, 12 months or more.)Yes No

Has applicant been a permanent resident for at least 4 years and 9 months?Yes No

If no, is the client applying based on marriage to USC and has been Yes No

LPR for at least 2 years and 9 months?

Applicant has 2.5 years/30 months of the last 5 years of physical presence (check trips made outside U.S.) in U.S. OR 1.5 years/18 mos. of last 3 yrs. if applying based on marriage to USC Yes No

*(if there have been many trips outside the U.S., you will have to calculate number of days applicant has been physically present in U.S.)

VII. DACA ELIGIBILITY

Are you interested in DACA or DACA Renewal?

On June 15, 2012, were you under the age of 31? Yes No

Are you at least 15 years old today? Yes No

How old were you when you first entered the U.S.? Were you under 16? Yes No

•Where did you enter the U.S.? (approximate place)

•How did you enter the U.S.? (i.e. without documents, with visa, etc…)

Were you physically present in the U.S. on June 15, 2012? Yes No

(Applicant must also be physically present in the U.S. on the date he or she applies for DACA.)

Were you in the U.S. unlawfully as of June 15, 2012? Yes No

(Either by entering the U.S. unlawfully before June 15, 2012 or because your lawful immigration status expired, such as an I-94 or border crossing card on or before June 15, 2012)

If you entered on a visa, were you out of status on June 15, 2012? Yes No

When did you enter the U.S. last? (before June 15, 2007).

Have you continuously lived in the U.S. since June 15, 2007? Yes No

If you ever left the U.S. since your first arrival, please list the dates:

Have you or your parents ever been in removal proceedings? Yes No

Have you ever served in the Military? Yes No

Have you ever been arrested (even if you were not convicted)? Yes No

VIII. ASYLUM ELIGIBLITY

What date did you arrive in the U.S?______Was this your first visit to the U.S.?  Yes  No

If no, please list all other trips to the U.S.:

Date of Entry:______Date of Exit:______Purpose of Trip:______

Before coming to the U.S., did you visit or live in any other countries? If so, which ones:

Country: ______Dates of Stay:______Immigration Status in that Country______

Reason for Leaving:______

Are you afraid to go back to your country? Yes No

If yes, please explain who will harm you, and what they will do to you:

______

Please explain why this person/organization/group/family, etc., wants to harm you:

______

Why can’t the police, courts, or government officials help you or protect you:

______

Have you ever supported or participated in a group that hurt other people? If so, please explain what this group did.

______

Is there anywhere else in your country you can go to be safe? If not, why not, and how do you know that?

______

IX. T/U/VAWA ELIGIBILITY

Have you ever been hurt by anyone, or afraid of being hurt? Yes No

If yes, please explain what happened:

______

Who hurt or threatened you: ______

Is this person someone you knew: Yes No

What was your relationship to this person: ______

Did you live with this person: Yes No

Do you know if the person who hurt you has immigration status? If so, what status: ______

Were you legally married to this person? Yes No Are you divorced now? Yes No

Date of divorce:______

Even if the person never hit you, did the person sometimes intimidate you, insult you, insist that you not leave the house or restrict your communication with other people or family, make you be sexually intimate when you did not want to be, threaten to report your immigration status, threaten to take your children away, or otherwise threaten you? Yes No

***Note to attorney- do not ask the question like this. Instead, if you suspect that there may be a VAWA case and your client has not been forthcoming about the details, explore these kinds of power dynamics with your client and use the notes section to record details.

Did you ever call the police? Yes No If yes, what police station did you call: Yes No

Did you hear from the police again after you reported the incident? Yes No

If yes, what happened in the case? How did you help?

______

Did you ever skip a hearing, avoid calls from an investigator, or refuse to cooperate in the investigation? Yes No

Did the person who hurt or threatened you help you come to the U.S., or help you land on your feet in any way when you arrived in the U.S.? Yes No

If yes, what did this person promise or agree to help you do?

______

Did the person keep his or her promise, and did it match your expectations? Yes No

If no, why not?

______

Did you work for this person, or work for someone this person knew? Yes No If yes, please explain:

______

NOTES:______

______