Deferred Action for Childhood Arrivals (DACA)

Please fill out the form as best you can at least 30 minutes before the consultation.
Your answers will be kept strictly confidential. Please answer these questions accurately to the best of your ability.
Contact Information
Overall goal of consult/ what is the main issue that needs to be resolved during consult?*
E-mail
ex: myname@example.com
Phone Number*

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Alien's Information
Alien's Full Name*

First NameLast Name
Birth Date

MonthDayYear
Country of Birth
Visa Status, if any
Have you ever served in the military?

YesNo
Marital Status
If married, is your spouse:
Entries and Exits
Alien's First Entry into US (MM-DD-YYYY) Approx.
How did you enter?
Where did you enter (city, state)?
Alien's Last Entry into US (MM-DD-YYYY)
How did you enter?
Requirements for Deferred Action
Came to the United States before the age of sixteen?

YesNo
If yes, can you provide proof ( school records, bills, vaccinations, etc.)?

YesNo
If proof is available, what kind of proof do you have?
Have you continuously resided in the United States since June 15, 2007 and were present in the United States on June 15, 2007?

YesNo
Have you left the US since June 15, 2007?

YesNo
If yes, please explain:
Would you be able to find proof for each year since 2007 to now that you have bene in the US? Yes or No

YesNO
Are currently in school, have graduated from high school, have obtained a general education development certificate, or are honorably discharged veterans of the Coast Guard or Armed Forces of the United States?

YesNo
If so, which one?
GED, HS diploma, bachelors, masters, etc.
Have you been arrested, charged or convicted of any crimes in the US or anywhere else in world? Including anything that may have been expunged and include even if plead no contest, deferred adjudication, deferred prosecution, pretrial diversion, or anything similar.

YesNo
If so, please explain and bring records to the consultation.
What was your immigration status on June 15, 2012?
Legal History ( from immigrant's point of view)
Have you ever been detained by the police or immigration?
Are you now or have you ever been in removal proceedings?

YesNo
If yes, explain:
Have you ever made a false claim to US citizenship?

YesNo
Have you ever committed any fraud to immigration?

YesNo
Have you ever applied for asylum?

YesNo
Have you previously applied for an Immigration Petition?

YesNo
If yes, explain:
Have you ever been refused entry into the US?

YesNo
Have you ever been apprehended at the border while attempting to unlawfully enter the United States?

YesNo
If yes, please explain (give dates, and circumstances surrounding unlawful entry):
Have you been convicted of three or more misdemeanors?

YesNo
If yes, please list the charge and date of the convictions.
Have you been convicted of domestic violence, sexual abuse, burglary, unlawful possession of firearm, drug distribution or trafficking, or driving under the influence?

YesNo
If yes, please list the charge and date of the convictions.
Have you spent 90 days or more in jail?

YesNo
If yes, please list the offense for which you served time in jail.
To the best of your knowledge, have you ever been issued a final order of removal?

YesNo
If yes, please explain (list date and circumstances).
The answers to the above questions I have provided are correct and true to the best of my knowledge.

YesNo
Conclusion
How did you learn about the law firm?*
Other
Name of the person completing the intake sheet:
Date (MM-DD-YYYY)
Which location will your consultation take place?
How would you prefer your consultation?
Would you like to receive immigration updates through our Newsletter?*

YesNo, thank you.
Should be Empty:

Please fill out the form as best you can at least 30 minutes before the consultation.

Contact Information

Alien's Information

Entries and Exits

Requirements for Deferred Action

Legal History ( from immigrant's point of view)

Conclusion