* Name

Address

Work Phone

Home Phone

Pager/Cell Phone

Fax

* Email

The questionnaire assumes that you are the foreign national seeking help. Check the sentence(s) that best describes your problem and answer the questions that apply for you:

I last entered the U.S.

Date last entered:

Place last entered:

If you entered with permission, what type of visa did you enter with?

When does this visa expire?

I am a citizen of the following country:

I want work permission

I want to extend my non-immigrant visa

I want legal permanent residence

I want to get U.S. citizenship

A U.S. citizen or legal permanent resident family member wants to apply for me. Their relationship to me is:

I, or a family member of mine, have had an immigrant petition filed for me (or them) in the past

I am in deportation proceedings. I got into deportation proceedings because:

I have received a voluntary departure or deportation in the past

I have been either arrested, charged, indicted or convicted of a crime (please mark this even if the charges were dismissed and whether or not the crime was a felony or misdemeanor)