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Immigration Intake Form - Law Office of Amira Al-Alami
CONFIDENTIAL INFORMATION

Please answer all questions accurately and completely. this information will be used to determine if our office is interested in forming an attorney/client relationship in the future. no attorney/client relationship is established by providing this information.
Attention: This document is a confidential internal law office document, and it will remain at our office and will be kept confidential.
1. Date *
MM
/
DD
/
YYYY
2. How did you learn about our office? *
Friends, Family, Facebook, Website, Google, etc.
3. Name *
4. Adress *
5. City *
6. State *
7. Zip Code *
8. Home Number *
9. Work Number *
10. Cellphone *
11. Date of Birth *
MM
/
DD
/
YYYY
12. Place of Birth *
13. Alien Identification Number *
14. Marital Status
Clear selection
15. If you choose "Other", explain Marital Status
(Only answer if you choose "Other")
If you are currently married, answer questions 16 to 18
16. Name of Spouse
17. Date of Birth
MM
/
DD
/
YYYY
18. Date of Marriage
MM
/
DD
/
YYYY
19. How many times have you been married? *
20. Complete Name, Age and Place of Birth of each Child
Answer only if you have children
21. Date of your FIRST entry to the US? *
MM
/
DD
/
YYYY
22. Port of Entry *
23. How did you enter the US? *
24. Have you ever been detained by immigration? *
25. If you have ever been detained, indicate the date.
MM
/
DD
/
YYYY
26. Have you ever been arrested by the police? *
Indicate the dates
MM
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DD
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YYYY
MM
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DD
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YYYY
MM
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DD
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YYYY
27. Have you ever been deported by Immigration? *
Where?
When?
MM
/
DD
/
YYYY
28. What is your current immigration status? *
29. Have you ever received government aid? *
When?
MM
/
DD
/
YYYY
30. Have you ever been a victim of a crime? *
When
MM
/
DD
/
YYYY
31. Did your Parents/Spouse become residents prior to 1977? *
When
MM
/
DD
/
YYYY
32. Do you have immediate family who are US citizen or lawful residents? *
Indicate Name and Relationship
33. E-mail address *
Submit
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