All information contained in the following Immigration Consultation Questionnaire will be kept STRICTLY CONFIDENTIAL and will not be released without your permission.
 INFORMATION ABOUT YOU
 Name

Last :

First :

Middle :
 Other names used (including maiden name) : Sex: Male   Female
  Current Address in U.S.
Number and Street : City :
State : Zip :
  Last Address Outside of U.S.
Number and Street : City :    
State / Province : Postal Code :    

Country :

  
Home Phone :
Hours we can call :
Fax Number : Work Phone :
Hours we can call :
Pager/Cell Phone :
Social Security No : Citizen of :
  Date and Place of Birth
Date of Birth : ( MM / DD / YYYY ) City or Town :
State or Province : Country :  
Passport Information : Passport Country :
Passport Number : Expiration Date : ( MM / DD / YYYY )
  Family Information
   Husband or Wife :  In the U.S. Outside of U.S. Unmarried
  Spouse's Name

Last :

First :

Middle :
   Current Address (put "same" if you live together) :
  Date and Place of Birth
   Date and Place of Marriage :
  Citizen of :
Applying with you? : Yes  No
Social Security Number : Alien ("A") Number  :
  Immigration Status:
   Expiration Date : Month : Day :
  Children:

Total Number of Sons and Daughters :

Name

 Sex Date of Birth Citizen of Immigration
  Status		 Expiration
Date		 Applying
with You?
 
  Applicant's Parents

Name :

Country of Birth  :

  

Citizen of Birth :

  

Immigration Status :

Your Father :

 U.S. Citizen
 

Permanent Resident Resides Abroad
 

Deceased
 

Other  

Your Mother* :

 U.S. Citizen
 

Permanent Resident Resides Abroad
 

Deceased
 

Other  

Spouse's Father :

 U.S. Citizen
 

Permanent Resident Resides Abroad
 

Deceased
 

Other  

Spouse's Mother* :

 U.S. Citizen
 

Permanent Resident Resides Abroad
 

Deceased
 

Other  
 

Use Mother's Maiden Name  *          

   Previous Marriages ( Check if Not Applicable)

Yours :

Ended by :
Name :

Date of Marriage :

 ( MM / DD / YYYY )
Country of Marriage :

Reason for Termination of Marriage :

Date of Termination of Marriage :

 ( MM / DD / YYYY )  

Country of Termination of Marriage :