Consultation Questionnaire

IMMIGRATION LEGAL TEAM - CONSULTATION QUESTIONAIRE

**(PLEASE PRINT)**

Information about the individual attending the Consultation:

Date:___________________________________

Full Name:_______________________________________________________

Date of Birth: ______________

Address:__________________________________________________________________________________

(Street) (Apt. #) (City) (State) (Zip)

Phone (work):_____________Phone (home):_____________E-mail address: _____________________________

Fax (home):_______________________Fax (work): _______________________

Referred to BOGLE & CHANG, LLC by: ________________________________

Brief description of the factual situation leading you to seek a consultation from BOGLE & CHANG:

______________________________________________________________________________________________________

Information from the Foreign National: (If person attending the consultation is not the foreign national, please complete the information that youknow concerning the foreign national who is the subject of the consultation)

Is the foreign national in the U.S.? ________ & If so, last date of entry to U.S: _____________________________

Status at time of entry:_____________________(Tourist, Student, Without inspection, etc.)

Expiration date of I-94______________________________________

Immigration Number (As contained on foreign national's work card, green card or any documents for the UCIS or Court) A#:_____________________________

Social Security Number (if any):_____________________________________________________________________

Other names used:_____________________________________________________________________

Foreign national's place of birth (city/state/Country):___________________________________________________

Any right to citizenship in country other than country of birth: Yes____ No____Is the foreign national employed by a U.S. employer?

Yes____ No____

If so, name and address of U.S. Employer:______________________________________________________________________________________________

______________________________________________________________________________________________________

Please provide the foreign national's prior periods of stay in the United States and type of visa:

(From) ;(To)

(Type)________________________________________________________________________________________________

______________________________________________________________________________________________________

_________________________________________________________________

Has the foreign national ever stayed beyond the date on the I-94 Arrival/Departure record?:________________

Has the foreign national ever worked without Citizenship and Immigration Service Permission?: ______________

Marital Status of foreign national (circle one): Single____ Married____ Divorced ____Widowed ____ Civil Union ____

Spouse's Name:____________________________________________ (Husband or Wife, also give maiden name for wife)

Date of Marriage:______________________Place of Marriage:_________________________________________ (City, State, Province, Country)

Spouse's Status in the U.S.:__________________________________

Location of Spouse:________________________________________

If spouse is not a U.S. citizen, please provide all prior periods of stay in the United States by spouse of foreign national and type of visa:(From) (To) (Type )

______________________________________________________________________________________________________

________________________

List children with Date, Place of birth (City, State, Country);

current immigration status if in U.S.:_________________________________________________________________________

______________________________________________________________________________________________________

____________________________

Provide all prior periods of stay in the United States by children and type of visa:(From) (To) (Type )

______________________________________________________________________________________________________

________________________________________________________________________________

(Any children born in U.S.?

If so, please indicate.)____________________________________________________________________________________

______________________________________________________________________________________________________

Does the Foreign National have any U.S. Citizen parents or grandparents? Yes____ No

Please provide details if known:_______________________________________________________________________________________________

_____________________________________________________________________________________________________

Has the foreign national ever appeared before an Immigration Judge?: Yes___ No ___

When:____________ Where:________________________Result:_______________________

Attorney on case:______________________________Phone:______________________________

Previous applications made to USCIS (formerly INS): ______________________________________________________________________________________________________

____________________________________________

Is the foreign national afraid to return to his/her country of Citizenship/Nationality?

Why?_________________________________________________________________________________________________

______________________________________________________________________________________________________

Please list any arrests, charges and/or convictions including traffic violations:

______________________________________________________________________________________________________

Has the foreign national ever been fingerprinted for any reason, whatsoever?______________

For Yes, Explain circumstances_____________________________________________________________________________

When_______________________Where_____________________________________________________________________

____________________________________________________________________Why______________________________

______________________________________________________________________________________________________

I understand that providing this information to BOGLE & CHANG, LLC is for the purpose of obtaining a Consultation and is not intended for the purpose of establishing an attorney client relationship until I have executed a written Legal Services Agreement entering into such a relationship with the BOGLE & CHANG, LLC.

Completed By:________________________________________________________

Signature ___________________________________________________________

PRINT NAME ________________________________________________________

DATE: ________________________________________________________

BOGLE & CHANG, LLC

Phone: (800) 342-1733

Fax: (617) 674-2396

Email to: lawyer@immigrationlegalteam.com