Background Information Intake for Immigration Clients

This form lets immigration law firms gather a client's personal, family, and immigration history before beginning any legal proceedings.

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In the Claude connectors directory

Legal Server Number

Date of Intake

Birth Date

Phone

Secondary Phone Number

Physical Address

Street Address

City

State / Province

ZIP / Postal Code

Mailing Address:

Same as physical address Different

Mailing Address

Street Address

City

State / Province

ZIP / Postal Code

E-mail

Gender Identity

Primary Language

Spanish English Other

English Ability

None Basic Fluent

Are you currently being represented by an attorney?

Yes No

Ethnicity

Hispanic or Latino Not Hispanic or Latino

Eye Color

Brown Blue Green Other

How did you hear about us?

Friend or family Attorney referral Online Other

Marital Status:

Single Married Divorced Widowed

Date of Marriage:

Spouse Immigration Status:

U.S. Citizen Permanent Resident Undocumented Other

Do you have any children?

Yes No

Client Immigration status in the U.S.

U.S. Citizen Permanent Resident Undocumented Other

Is/was either of your parents a U.S. Citizen or Legal Permanent Resident?

Yes No

If U.S. Citizen, how?

If applicable, date of Naturalization

Were either of your grandparents U.S. citizens when your parents were born?

Yes No

Do you have a spouse, parent, or child who is active duty in the U.S. Armed Forces?

Yes No

Has anyone ever filed an immigration petition for you or your parents?

Yes No

If YES, was it before 04/30/2001?

Yes No

Do you have an A-Number (A#)?

Yes No

If yes, enter your A#:

Name of Staff/Advocate completing intake:

First Name

Last Name

Language(s) spoken during intake:

Spanish English Portuguese Other

Interpretation used:

Yes No

Voiance/Phone interpretation service

Yes No

Voiance Number

Other interpreter used

Documents Reviewed (check all that apply)

Intake Notes if any:

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