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2. Other names used
Email *
Phone Number *
3. Country of birth *
4. Country of citizenship *
5. Are you presently in the United States? * Please select Yes No
6. When did you last enter the United States? Please indicate the date in "Month/Day/Year" format. *
7. Did you use any documents to enter the United States? * Please select Yes No
If yes, which document did you use?
8. Have you ever had a U.S. visa or other document to legally enter the United States? * Please select Yes No
If you answered "Yes" to the question above, please confirm all types of U.S. visas or documents you have held.
9. Was the last time you entered the United States your first time entering the country? * Please select Yes No
If you answered "No" to the question above, please list all your trips to the Unites States, including the date of entry, date of departure, and the type of document you used to enter the country. If you entered wihtout any documents, please write "entered without documents."
10. Have you ever had a J-1 or J-2 visa? If "Yes", please provide a copy of the J-1/J-2 visa in your passport and a copy of your Form DS-2019. * Please select Yes No
11. Have you ever applied for an immigration benefit for the United States? An immigration benefit may include things like a visa, border crossing card, work permit, parole, DACA, TPS, green card, or U.S. citizenship. Forms include: I-130, I-485, I601 or I-601A waiver, I-140, PERM or labor certificate, I-129F, I-821 (TPS), I-765 (work permit), I-131 or I-134 (parole), I-821D (DACA), I-360, I-589 (asylum), I-192, I-730, I-129 for work visas, I-539, I-918 (U visas), Visa applications (DS-156; DS-230; DS-160; DS-260) * Please select Yes No
If you answered "Yes" to the question above, please provide as many details as you can remember about the case you filed.
12. Has anyone ever sponsored you for a green card in the past? * Please select Yes No
If you answered "Yes" to the question above, please provide as many details as you can remember about the case. Include the name of the person who sponsored you, their immigration status, the type of case, when the case was filed, case number (if available), and case status.
13. Do you have any family members that are U.S. citizens or green card holder? * Please select Yes No
If you answered "Yes" to the question above, please indicate the relationship to you (parent, spouse, child, brother/sister, aunt/uncle). Please select Parent Spouse Child Brother/Sister Aunt/Uncle Grandparent Other family member
If you answered "Yes" to the question above, please indicate the Immigration status (U.S. citizen or green card holder). Please select U.S. citizen Green card holder
14. Have you ever had any problems entering the United States? Please answer "Yes" to this question if you were caught by Border Patrol after attempting to unlawfully enter the United States. * Please select Yes No
If you answered "Yes" to the question above, please include as many details as you can remember. Include dates of entry, description of what you can remember and the outcome.
15. Have you ever been cited for, arrested for, or convicted of a crime in any part of the world? This includes speeding tickets. * Please select Yes No
If you answered "Yes" to the question above, please include as many details as you can remember, including dates, description of the incident and the outcome.
16. Are you opposed to any vaccinations? * Please select Yes No
17. Have you ever asked for asylum in the United States? * Please select Yes No
18. Have you ever been in immigration court in the United States? * Please select Yes No
If you answered "Yes" to the question above, please provide the date and location where you had your court case. If available, please also provide your Alien Number ("A-Number"; "File Number"; or "USCIS Number").
the where 11.
19. Have you ever had to use any type of public welfare programs in the United States? * Please select Yes No
If you answered "Yes" to the question above, please provide details including the state that gave you the benefits, which benefits you received, and the date you received them.
20. Have you ever worked in the United States? * Please select Yes No
21. Have you ever studied in the United States? * Please select Yes No
22. Have you ever served in the military of any country? * Please select Yes No
If you answered "Yes" to the question above, please provide the country where you served, the branch of service, and dates of service.
23. Have you ever been affiliated or associated in any way with a communist party in any part of the world? * Please select Yes No
24. Have you ever visited any of the following countries? Cuba; Iran; North Korea; Syria. * Please select Yes No
If you answered "Yes" to the question above, please provide the name of the country.
25. Have you ever been the victim of a crime that occurred in the United States? * Please select Yes No
If you answered "Yes" to the question above, please provide details, including the type of incident, location of the incident, date of the incident and the outcome of the incident.
26. Is there anything else you'd like us to know? Feel free to use this space wo write any information you believe may be relevant to your immigration history.
