CONTACT INFORMATION

Current Legal Name Last         First         Middle

Other names used (including maiden name)

Date of Birth Nationality   Citizenship
(
Month/Day/Year)
  Place of Birth State/Province Country 
(Town/Village)
  Sex: M F            Race
Height: feet inches           Weight in pounds   Hair Color Eye Color
  U.S. Social Security No.
Your Contact Information Home Phone     E-mail * (required)   

Business Phone    Fax    Alternative Phone
Present Home Address:

Business Address:


Address in the United States where you will reside (if not currently in the U.S.):

Present occupation: If "Other" please explain:
 

PRIOR RESIDENCES

Residences last five years.  (Present address first)
Street Address / Apartment number / City / State / Zip / Country / From / To (Month, Year):




Last address outside of U.S. of more than one year
(address and phone number abroad if you are not in the United States)
Street Address / Apartment number / City / State / Zip / Country / From / To (Month, Year):


 

Please complete if you are currently outside of the U.S. (if not applicable, skip this part):

Full name, address and phone number(s) of contact person or organization in the United States:

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List all countries you have entered in the last ten years (give the year of each visit):

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List all countries that ever issued you a passport:


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Have you ever lost a passport or had one stolen: Yes  No
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National Identification Number (if applicable):
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Clan or Tribe name (if applicable):
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List all Professional, Social and Charitable Organizations to which you belong(ed) or contribute(ed) or with which you work(ed):

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Do you have any specialized skills or training, including firearms, explosives, nuclear, biological, or chemical experience: Yes  No
If "Yes" please explain:

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Have you ever performed military service: Yes  No
If "Yes" please list: Country / Branch of Service / Rank / Position / Military Specialty / Dates of Service:

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Have you ever been in an armed conflict, either as a participant or victim: Yes  No
If "Yes" please explain:

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Have you made specific travel arrangements: Yes  No
If "Yes" please provide a complete itinerary for your travel: Arrival & Departure dates / Flight Information / Specific Location(s) You Will Visit / Point of Contact at each Location:
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How long do you intend to Stay in the United States:
What is the purpose of your trip:

Who will pay for your trip:
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Have you ever been refused a U.S. Visa: Yes  No  When    Where
What type of Visa
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Have you ever been issued a U.S. Visa: Yes  No  When    Where
What type of Visa
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Have you ever been in the United States: Yes  No
If "Yes": When For how long
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Do you intend to work in the U.S.: Yes  No
Do you intend to study in the U.S.: Yes No
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Has your U.S. Visa ever been canceled or revoked: Yes No
Have you ever been refused admission to the United States: Yes No
Has anyone ever filed an immigrant visa petition on your behalf: Yes No
If answered "Yes" to any of the above, please explain below:

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Are any of the following persons in the U.S., or do they have U.S. Legal Permanent Residence or U.S. Citizenship (please indicate that person's status in the U.S.: i.e., U.S. legal permanent resident, U.S. citizen, visiting, studying, working, etc.):
Husband/Wife: Yes  No   Status
Fiance/Fiancee: Yes  No   Status
Father/Mother: Yes  No   Status
Son/Daughter: Yes  No   Status
Brother/Sister: Yes  No   Status

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Have you attended a U.S. public elementary school on student (F) status or a public secondary school after November 30, 1996 without reimbursing the school: Yes  No
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Have you ever been afflicted with a communicable disease of public health significance or a dangerous physical or mental disorder: Yes No
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Names and relationships of persons traveling with you:

 

 
SPONSOR/PETITIONER (if not applicable, skip this part) Please complete this part if you are a Sponsor or Petitioner of a person seeking immigration benefits.
I am sponsoring my (husband, wife, parent, brother, sister, child):
Are you related by adoption?                Yes No
Has your relative ever been in the U.S.? Yes No
Is your relative currently in the U.S.?     Yes No
Are you applying for an advance parole document for a person who is outside the U.S.?  Yes No
Will your relative apply for adjustment of status?  Yes No
Address in the U.S. where your relative intends to live:


If you are a U.S. citizen how did you acquire your citizenship (Birth in the U.S., Naturalization, Parents):
Have you obtained a certificate of citizenship in your name? Yes No
Certificate Number: Date, Place of issuance:

If you are a lawful permanent resident alien, complete the following:
Date, Place of Adjustment of Status:

Did you gain permanent resident status through:
Marriage to a U.S. citizen or lawful permanent resident?  Yes  No
Did you gain permanent residence through adoption?      Yes  No

If filing for your husband/wife, provide last address at which you lived together:
Street Address / Apartment number / City / State / Zip / Country  From / To (Month, Year):

Have you ever filed a petition for any foreign national before?   Yes  No
If you answered "Yes" to the above question provide the following: Name / Place / Date of filing / Results:

Are you, or any person you are sponsoring, now in exclusion, deportation, removal or recission proceedings?
Yes  No If "Yes" Name of DHS office

*Please note that a separate questionnaire should be completed by a relative you are sponsoring.

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If you applying for an advance parole document (permission to travel to the U.S.) for a person who is outside the United States, provide the following information about this person:

Current Legal Name:
Last         First         Middle
Date of Birth Country   Citizenship
(
Month/Day/Year)

Current Address:
Street Address / Apartment number / City / State or Province / Zip / Country / Daytime Telephone:

Date of intended departure (month/day/year)

Expected length of trip
 



FAMILY
  Name of Father: Last     First
Father's Place of Birth: City   State   Country
Father's Date of Birth:   Deceased?   Year
Father's Residence:
  Name of Mother: Last     First   Maiden
Mother's Place of Birth: City   State   Country
Mother's Date of Birth:   Deceased?   Year
Mother's Residence:
  Were any of your grandparents born in the U.S.?             Yes No
If so where:
  Marital Status     Date of present marriage
Number of times married, including this marriage
Spouse’s Name:
Last First Middle Maiden
Spouse's Place of Birth  
Spouse’s Date of Birth  (
Month/Day/Year)
Spouse's Citizenship    
Spouse’s U.S. Social Security No.
Place of present Marriage 
Information about your former spouse(s)
(1) Former Spouse’s Name:
     Last First Middle Maiden
     Former Spouse’s Date of Birth  (
Month/Day/Year)
     Former Spouse's Citizenship    
     Date of Termination of Marriage or Death    Where?

(2) Former Spouse’s Name:
     Last First Middle Maiden
     Former Spouse’s Date of Birth  (
Month/Day/Year)
     Former Spouse's Citizenship    
     Date of Termination of Marriage or Death    Where?

List Children, Including Stepchildren:  (1) Name Relationship
      DOB City, State of Birth
      Country of Birth
      Address (if different):
       
       U.S. Soc. Sec. No. “A” No. (if applicable)
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 (2) Name Relationship
      DOB City, State of Birth
      Country of Birth
      Address (if different):
       
       U.S. Soc. Sec. No. “A” No. (if applicable)
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 (3) Name Relationship
      DOB City, State of Birth
      Country of Birth
      Address (if different):
       
       U.S. Soc. Sec. No. “A” No. (if applicable)
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 (4) Name Relationship
      DOB City, State of Birth
      Country of Birth
      Address (if different):
       
       U.S. Soc. Sec. No. “A” No. (if applicable)
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 (5) Name Relationship
      DOB City, State of Birth
      Country of Birth
      Address (if different):
       
       U.S. Soc. Sec. No. “A” No. (if applicable)

EDUCATION Education: High School? College?
Degrees Earned and Date Earned 
 
If applying for a work visa or you are currently outside of the United States please complete detailed information below:

(1)

Names, Addresses, Phone Numbers of Schools, Colleges and Universities Attended (include trade or vocational training facilities):

Field of Study: From (month/year): To (month/year):
Degrees or Certificates Received:
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(2)

Names, Addresses, Phone Numbers of Schools, Colleges and Universities Attended (include trade or vocational training facilities):

Field of Study: From (month/year): To (month/year):
Degrees or Certificates Received:
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(3)

Names, Addresses, Phone Numbers of Schools, Colleges and Universities Attended (include trade or vocational training facilities):

Field of Study: From (month/year): To (month/year):
Degrees or Certificates Received:
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(4)

Names, Addresses, Phone Numbers of Schools, Colleges and Universities Attended (include trade or vocational training facilities):

Field of Study: From (month/year): To (month/year):
Degrees or Certificates Received:
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(5)

Names, Addresses, Phone Numbers of Schools, Colleges and Universities Attended (include trade or vocational training facilities):

Field of Study: From (month/year): To (month/year):
Degrees or Certificates Received:
 

 

EMPLOYMENT

Current occupation

Employment last five years.  (Present employment first)
Name / Address / Telephone Number / Supervisor's Name / Occupation /Salary / From / To (Month, Year):






Current Employer’s Tax Identification Number

If you are applying for Employment Authorization Document, complete the following:
Have you ever before applied for Employment Authorization Document? Yes No
If "Yes", Which USCIS Office
  Date(s)   Results
I am applying for permission to accept employment
I am applying for replacement of lost Employment Authorization Document
I am applying for renewal of my permission to accept employment

If applying for work visa complete the following:
Name and address of (prospective) employer:

List all jobs held during the last three years. Also, list any other jobs related to the occupation for which you are seeking work visa:

(1)

Name and address of employer:

Name of Job Kind of business No. of hours per week
Date started (month/year) Date left (month/year)
Describe in detail the duties performed, including the use of tools, machines or equipment:

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(2)

Name and address of employer:

Name of Job Kind of business No. of hours per week
Date started (month/year) Date left (month/year)
Describe in detail the duties performed, including the use of tools, machines or equipment:

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(3) Name and address of employer:

Name of Job Kind of business No. of hours per week
Date started (month/year) Date left (month/year)
Describe in detail the duties performed, including the use of tools, machines or equipment:

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(4) Name and address of employer:

Name of Job Kind of business No. of hours per week
Date started (month/year) Date left (month/year)
Describe in detail the duties performed, including the use of tools, machines or equipment:

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(5) Name and address of employer:

Name of Job Kind of business No. of hours per week
Date started (month/year) Date left (month/year)
Describe in detail the duties performed, including the use of tools, machines or equipment:

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(6) Name and address of employer:

Name of Job Kind of business No. of hours per week
Date started (month/year) Date left (month/year)
Describe in detail the duties performed, including the use of tools, machines or equipment:

 

ARRIVAL IN THE UNITED STATES Date/Place of arrival in U.S. (Month/Day/Year/Place) 
Has a prior visa petition ever been filed?

If YES, then answer the following:
Where When Approved?

Means of travel into U.S. Inspected?

Status at entry (visitor, student)

Passport No. Issue Date Expiration Date

Passport was issued: City   Country   State/Province

Destination in U.S. at Time of Admission

Consulate Where Visa Issued   Visa Number

Date Visa Issued   Visa Expiration Date OR Indefinite (yes/no)

Visa Classification

I-94 Number   Issue Date   Expiration Date

Duration of Stay

Name Exactly as it Appears on I-94

Have you ever filed for Permanent Residence in the U.S.?

If yes, give date and place of filing

“A” Number as it appears on Lawful Permanent Residence (Green) Card

Most recent dates and ports of entry in the United States:

 

FUTURE TRAVEL (if not applicable, skip this part)  
I am a permanent resident of the United States
I am holding U.S. refugee/asylee status
I am a permanent resident as a direct result of refugee/asylee status
I am applying for an advance parole document to allow me to return to the United States after temporary foreign travel
I am outside the United States and I am applying for an advance parole document

Date of intended departure (month/day/year)

Expected length of trip
How many trips do you intent to use the travel document: One trip   More than one trip

Have you ever before been issued a reentry permit or refugee travel document: Yes No
Date issued (month/day/year)
Disposition : Lost Stolen Other

Information about your proposed travel:

Since becoming a permanent resident of the United States (or during the past five years, whichever is less) how much total time have you spent outside the United States:
less than six months two to three years
six months to one year three to four years
one to two years more than four years

Since you became a permanent resident of the United States, have you ever filed a federal income tax return as a nonresident, or failed to file a federal tax return because you consider yourself to be a nonresident?
Yes No
If "Yes" please explain:
Where do you want this travel document sent (Number and Street, Apt.#, City, State or Province, Zip/Postal Code, Country, Daytime Telephone # with area/country code):
 

BACKGROUND INFORMATION
List ALL present/past membership in groups of any kind
Group Name / Location (City, State) / From / To (Month, Year):

Have you ever committed a crime?   been arrested? been granted pardon?
(include all traffic tickets)

If answered YES to any of the above, give the following information
Date / Place (City / State / Country) / Nature of Offense / Outcome:


Have you ever been given public assistance?
If "Yes", explain:

Have you ever:

  Committed or charged for a crime or offense for which you were not arrested?  
Y N
       
  Been arrested, cited, charged, indicted, fined or imprisoned for breaking             
a law, excluding traffic violations?
 
Y
       
  Been the recipient of an act of clemency or similar action?    
Y N
       
  Exercised diplomatic immunity to avoid prosecution in U.S.?   
Y
       
  Been declared legally incompetent or been confined to a mental institution within the last 5 years?  
Y N
       
  Received public assistance in U.S. from any source, or likely to in the future?   
Y
       
  Engaged in prostitution in past 10 years, or likely to in future?   
Y N
       
  Encouraged any alien to enter U.S. illegally?  
Y
       
  Trafficked in any controlled substance?   
Y N
       
  Been in any way involved in any terrorist activity?   
Y
       
  Engaged in espionage or intend to once in the U.S.?    
Y N
       
  Been a member of or affiliated with the Communist Party or Nazi government of Germany between March 23, 1933 and May 8, 1945?      
Y
       
  Engaged in genocide or persecuted any person because of race, religion,
national origin or political opinion?   
 
Y N
       
  Been deported, removed, or excluded from the U.S. or been ordered to do same?    
Y
       
  Committed fraud in order to obtain entry into the U.S.?              
Y N
       
  Left the U.S. to avoid being drafted into the U.S. Army?    
Y
       
  Been a "J" nonimmigrant visitor and not complied with the 2-year foreign
residence requirement or obtained a waiver?   
 
Y N
       
  Withheld custody of a U.S. citizen child from a person granted custody of
the child?   
 
Y
       
  Been a polygamist or plan to practice polygamy in the U.S.?   
Y N
       
  Claimed to be a U.S. citizen (in writing or any other way)?     
Y
       
  Violated or evaded laws prohibiting the export of goods, technology or information from the Unites States?   Y
       
If answered "Yes" to any of the above, explain fully below:
  Have you ever been under immigration proceedings?  
Y
  Removal       Exclusion/Deportation       Recission       Judicial Proceedings    
  If you answered "Yes" to the last question please state:
Where When
   
       
 
NATURALIZATION APPLICANTS ONLY (if not applicable, skip this part)

How many total days did you spend outside of the United States during the past 5 years?

How many trips of more than 24 hours have you taken outside of the U.S. during the past 5 years?

 

List below all the trips of 24 hours or more that you have taken outside of the United States since becoming a Lawful Permanent Resident.  Begin with your most recent trip.

Date Left U.S. / Date Returned to U.S. / Countries to which you have traveled:




 

  Have you ever voted in any Federal, state, or local election in the United States?   
Y N
       
  Have you ever registered to vote in any Federal, state, or local election in the U.S.?  
Y
       
  Since becoming a Lawful Permanent Resident (Green Card holder), have you ever failed to file a required Federal, state, or local tax return or called yourself a “nonresident” on same?   
Y N
       
  Do you owe any Federal, state, or local taxes that are overdue?   
Y
       
  Do you have any title of nobility in any foreign country?    
Y N
       
  Have you ever been arrested, cited, or detained by any law enforcement officer (including INS, now USCIS and military officers) for any reason?   
Y
       
  Have you ever been placed in an alternative sentencing or rehabilitative program (for example: diversion, deferred prosecution, withheld adjudication, deferred adjudication)?   
Y N
       
  Have you ever received a suspended sentence, been placed on probation, or been paroled?  
Y
       
  Have you ever been in jail or prison?  
Y N
       
  Have you ever been a habitual drunkard?  
Y
       
  Have you ever helped anyone enter or try to enter the United States illegally?   
Y N
       
  Have you ever gambled illegally or received income from illegal gambling?    
Y
       
  Have you ever failed to support your dependents or to pay alimony?    
Y N
       
  Have you ever given false or misleading information to any U.S. government official while applying for any immigration benefit or to prevent deportation, exclusion, or removal?   
Y
       
  Have you ever lied to any U.S. government official to gain entry or admission into the United States?     
Y N
       
  Have you ever served in the U.S. Armed Forces or applied for any kind of exemption from military service?     
Y
       
If answered "Yes" to any of the above, explain fully below. Please include the reasons, dates, locations, and outcome of any arrest, citation, detention or charge.
  Are you a male who lived in the United States at any time between your 18th and 26th birthdays in any status except as a lawful nonimmigrant?  
Y N

*PLEASE NOTE: If you answered “Yes” to the previous question, but did NOT register with the Selective Service System and you are still under 26 years of age, you must register before you apply for naturalization.  If you answered “YES” to the previous question, but did NOT register with the Selective Service System, and you are now 26 years or older, attach a statement explaining why you did not register.
 
IMMIGRATION ISSUES

How can the LL.M. Law Group help you?
   
Travel Document
Employment Authorization Card
Adjustment of Status
Work Visa
Student Visa
Investor Visa

Other, please specify:

By submitting this Questionnaire, I certify that all of the information contained in this Questionnaire is true and correct to the best of my knowledge and that I will be truthful in all future exchanges with the LL.M. Law Group regarding any personal information.

 

Please note that you will be required to provide copies of all supporting documents, such as your passport, visa, front and back of your I-94 card, your permanent residency card, and employment authorization document, if applicable, by mail or at the time of consultation.