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FAMILY IMMIGRATION INTAKE FORM
INFORMATION ABOUT YOU (PETITIONER)
What relationship is the relative you are applying for?
*
Are you related by adoption?
Are you related by adoption?
A
Yes
B
No
Did you gain permanent residence through adoption?
Did you gain permanent residence through adoption?
A
Yes
B
No
Name
*
Address
*
Phone Number
*
Email
*
Your place of birth
*
Your DOB
*
Your Sex
*
Your marital status
*
Other names used (including maiden name)
Date and place of your present marriage (if married)
Your Social Security number
*
Your Alien Registration number (if any)
Name(s) of prior spouse(s)
Date previous marriage ended
Are you a U.S. Citizen?
*
Are you a U.S. Citizen?
A
Yes
B
No
How did you acquire citizenship?
*
How did you acquire citizenship?
A
Through Birth in the U.S.
B
By Naturalization
C
Through Parents?
What is your Naturalization number; when and where was it issued?
If through parents, have you obtained a certificate in your own name?
If through parents, have you obtained a certificate in your own name?
A
Yes
B
No
What is the number of the certificate and when and where was it issued?
If you are a lawful permanent resident alien, when and where did you adjust?
Did you gain your lawful permanent resident status through marriage to a U.S. Citizen or lawful permanent resident?
*
Did you gain your lawful permanent resident status through marriage to a U.S. Citizen or lawful permanent resident?
A
Yes
B
No
What is your occupation?
*
INFORMATION ABOUT YOUR RELATIVE (BENEFICIARY)
What is your relative’s name?
*
What is your relative’s address?
*
What is your relative’s telephone number?
*
What is your relative’s email address?
*
What is your relative’s place of birth?
*
What is your relative’s date of birth?
*
What is your relative’s sex?
*
What is your relative’s marital status?
*
Has your relative used other names (including maiden name)?
*
What is your relative’s date and place of their present marriage (if married)?
What is your relative’s Social Security number?
What is your relative’s Alien Registration number?
What are the names of your relative’s prior husbands/wives?
When did their previous marriage(s) end?
Has your relative ever been in the U.S.?
*
Has your relative ever been in the U.S.?
A
Yes
B
No
If your relative is currently in the U.S., how did he/she last arrive?
*
What consulate did your relative obtain his/her Visa?
When was the visa issued?
What is the visa number?
What is the place of your relative’s last entry?
*
Was your relative inspected by a U.S. Immigration officer?
*
Was your relative inspected by a U.S. Immigration officer?
A
Yes
B
No
What is your relative’s Arrival/Departure Record (I-94) Number?
*
What is the name on your relative’s I-94 card?
When did your relative last arrive?
*
What is the name and address of your relative’s present employer (if any)?
When did this employment begin?
What is your relative’s occupations?
Has your relative ever been under any immigration proceedings? What type?
List your relative’s husband/wife and all children? (Name, Relationship, DOB, Country of Birth)
*
What is the address in the United States that your relative intends to live?
What is your relative’s address abroad?
If your relative’s native alphabet is other than Roman letters, write his or her name and address abroad in the native alphabet.
Signature
If filing for your husband/wife, give last address and dates for which you both lived together
Will your relative apply at the American Consulate or in the United States? Which consulate? Which INS Office?
If separate petitions are being submitted for other relatives, give names of each and relationship.
Have you ever filed a petition for this or any other alien before? If so, give name, place and date of filing and result.
*
Submit
