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You are here: Home / Questionnaire

Questionnaire

Step 1 of 20

5%

PETITIONER

Personal Information

Name
Any Other Names Used
All Other Names Used: (include names by previous marriages)
Gender:
Marital Status:

Height:

Weight:

Eye Color

Hair Color

Race
Residence Address
MM slash DD slash YYYY
Is Your Mailing Address is different from residence address
Mailing Address
MM slash DD slash YYYY

Birth Information

MM slash DD slash YYYY

Occupation

MM slash DD slash YYYY
MM slash DD slash YYYY
MM slash DD slash YYYY

Income Information


Note: After including your own income, you may also include income from any other person counted in your household. This may also include the beneficiary or intending immigrant.

Relative’s :
Relative’s name:
Relative’s current income:
Relationship:
 

Federal Income Tax Return Information

Please enter your income for the last three tax years.
Tax Year:
Total Income:
 

Asset and Tax Information

Relatives


Note: List your MOTHER AND FATHER, plus your CURRENT OR ANY PREVIOUS SPOUSE and ALL OF YOUR CHILDREN (including adult sons and daughters).

MOTHER

Name
MM slash DD slash YYYY
Applying with you?

FATHER

Name
MM slash DD slash YYYY
Applying with you?

CURRENT SPOUSE

Name
MM slash DD slash YYYY
MM slash DD slash YYYY
Name Middle Initial Maiden Name Date of Birth Date of Marriage Place of Marriage Date of Termination of Marriage Place of Termination of Marriage Actions
               
  • Edit
  • Delete
There are no Entries.

Maximum number of entries reached.

Name Middle Initial Maiden Name Date of Birth City of Birth Country of Birth Alien Number (if any) Applying with you? City of Residence Country of Residence Actions
                   
  • Edit
  • Delete
There are no Entries.

Maximum number of entries reached.

Residence Information

Address From To Actions
     
  • Edit
  • Delete
There are no Entries.

Maximum number of entries reached.

Please give your last address outside the United States of more than one year, if any.

Last address outside the U.S.:

Address
MM slash DD slash YYYY
MM slash DD slash YYYY

Employment Information

Employer Name: Address Occupation (Job Title): From To Actions
         
  • Edit
  • Delete
There are no Entries.

Maximum number of entries reached.

Please give information concerning your last occupation outside the U.S.

Employer Name:
Address
MM slash DD slash YYYY
MM slash DD slash YYYY

Applicant

Name
Any Other Names Used
Gender:
Marital Status:

Height:

Weight:

Eye Color

Hair Color

Race

Residence Address

Address
MM slash DD slash YYYY
Is Your Mailing Address Is Different from residence address
Address
MM slash DD slash YYYY

Birth Information

MM slash DD slash YYYY

Occupation

MM slash DD slash YYYY
MM slash DD slash YYYY
MM slash DD slash YYYY

I-94 Details

MM slash DD slash YYYY
Place of Last Entry into the U.S:
MM slash DD slash YYYY

Previous Applications

Have you ever applied for permanent resident status in the U.S.?

Affiliations or Associations


List your present and past membership in or affiliation with every organization, association, fund, foundation, party, club, society, or similar group in the United States or in other places since your 16th birthday. Include any military service in this part. If none, write “None.” Include the name of each organization, location, nature, and dates of membership.

Country
MM slash DD slash YYYY
MM slash DD slash YYYY

Excludability Issues

Have you ever, in or outside the United States, knowingly committed any crime of moral turpitude or a drug-related offense for which you have not been arrested?
Have you ever, in or outside the United States, been arrested, cited, charged, indicted, convicted, fined, or imprisoned for breaking or violating any law or ordinance, excluding traffic violations?
Have you ever, in or outside the United States, been the beneficiary of a pardon, amnesty, rehabilitation decree, other act of clemency or similar action?
Have you ever, in or outside the United States, exercised diplomatic immunity to avoid prosecution for a criminal offense in the United States?
Have you received public assistance in the United States from any source, including the U.S. Government or any state, county, city, or municipality (other than emergency medical treatment), or are you likely to receive public assistance in the future?
Have you ever, within the past 10 years, been a prostitute or procured anyone for prostitution, or intend to engage in such activities in the future?
Have you ever engaged in any unlawful commercialized vice, including, but not limited to, illegal gambling?
Have you ever knowingly encouraged, induced, assisted, abetted or aided any alien to try to enter the United States illegally?
Have you ever illicitly trafficked in any controlled substance, or knowingly assisted, abetted or colluded in the illicit trafficking of any controlled substance?
Have you ever engaged in, conspired to engage in, or do you intend to engage in, or have you ever solicited membership or funds for, or have you through any means ever assisted or provided any type of material support to any person or organization that has ever engaged or conspired to engage, in sabotage, kidnapping, political assassination, hijacking, or any other form of terrorist activity?
Do you intend to engage in the United States in espionage?
Do you intend to engage in the United States in any activity a purpose of which is opposition to, or the control or overthrow of, the Government of the United States, by force, violence, or other unlawful means?
Do you intend to engage in the United States in any activity to violate or evade any law prohibiting the export from the United States of goods, technology, or sensitive information?
Have you ever been a member of, or in any way affiliated with, the Communist Party or any other totalitarian party?
Did you, during the period from March 23, 1933 to May 8, 1945, in association with either the Nazi Government of Germany or any organization or government associated or allied with the Nazi Government of Germany, ever order, incite, assist or otherwise participate in the persecution of any person because of race, religion, national origin or political opinion?
Have you ever been deported from the United States, or removed from the United States at government expense, excluded within the past year, or are you now in exclusion, deportation, removal, or rescission proceedings?
Are you under a final order or civil penalty for violating Section 274C of the Immigration and Nationality Act for use of fraudulent documents or have you, by fraud or willful misrepresentation of a material fact, ever sought to procure, or procured, a visa, other documentation, entry into the United States, or any immigration benefit?
Have you ever left the United States to avoid being drafted into the U.S. Armed Forces?
Have you ever been a J nonimmigrant exchange visitor who was subject to the 2-year foreign residence requirement and have not yet complied with that requirement or obtained a waiver?
Are you now withholding custody of a U.S. Citizen child outside the United States from a person granted custody of the child?
Do you plan to practice polygamy in the United States?
Have you EVER served in, been a member of, assisted in, or participated in any military unit, paramilitary unit, police unit, self-defense unit, vigilante unit, rebel group, guerrilla group, militia, or insurgent organization?
Have you ever been a member of, assisted in, or participated in any group, unit, or organization of any kind in which you or other persons used any type of weapon against any person or threatened to do so?
Have you ever assisted or participated in selling or providing weapons to any person who to your knowledge used them against another person, or in transporting weapons to any person who to your knowledge used them against another person?
Have you ever received any type of military, paramilitary, weapons training?

Character Questions


Have you EVER ordered, committed, assisted, helped with, or otherwise participated in any act that involved:

Engaging in any kind of sexual contact or relations with any person who was being forced or threatened?
Limiting or denying any person’s ability to exercise religious beliefs?
Participating in acts involving torture or genocide?
Killing any person?
Intentionally causing severe injury to any person?
Serving in any prison, jail, prison camp, detention facility, labor camp, or any other situation that involved detaining persons?

Relatives


Note: List your MOTHER AND FATHER, plus your CURRENT OR ANY PREVIOUS SPOUSE and ALL OF YOUR CHILDREN (including adult sons and daughters).

MOTHER

Name
MM slash DD slash YYYY
Applying with you?

FATHER

Name
MM slash DD slash YYYY
Country of Birth
Applying with you?

CURRENT SPOUSE

Name
MM slash DD slash YYYY
Country of Birth
MM slash DD slash YYYY
Name Middle Initial Maiden Name Date of Birth Date of Marriage Place of Marriage Date of Termination of Marriage Place of Termination of Marriage Actions
               
  • Edit
  • Delete
There are no Entries.

Maximum number of entries reached.

Residence Information

Address From To Actions
     
  • Edit
  • Delete
There are no Entries.

Maximum number of entries reached.

Please give your last address outside the United States of more than one year.

Address
MM slash DD slash YYYY
MM slash DD slash YYYY

Employment Information

Employer Name: Address Occupation (Job Title): Date From Date To Actions
         
  • Edit
  • Delete
There are no Entries.

Maximum number of entries reached.

Please give information concerning your last occupation abroad.

Employer Name:
Address
MM slash DD slash YYYY
MM slash DD slash YYYY

Client Resources

May 15, 2017

 

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