DACA Renewal Intake Sheet
Email *
Have you ever filed a DACA application with our organization? *
What is your complete name? *
What is your nationality *
What is your age?
What is your gender?
Clear selection
What is your marital status? *
What is your phone number? *
When does your current DACA expire?
MM
/
DD
/
YYYY
What is your physical address? Please Include city state and zip code
What is your mailing address (If you don't want your work permit mailed to your physical address)
When did you enter the United States for the first time? *
Where did you enter the United States for the first time? *
Have you ever committed a moral crime or a crime involving drugs for which you have not been arrested? *
If yes, please explain
Have you ever been arrested, cited or detained or been in jail or prison? *
If yes, please explain
Have you ever been arrested by immigration at the border? *
If yes, please explain
Have you ever used a false document to gain entry to the United States? *
If yes, please explain
Have you ever been caught with false documents? *
If yes, please explain
Have you ever been fingerprinted crossing the border? *
If yes, please explain
Have you ever been deported? *
If yes, please explain
Have you ever received Unemployment Benefits in the United States? *
If yes, please explain
Have you ever applied and/or received public benefits for you and/or your children? Example: Food Stamps (SNAP), Welfare, Medicaid or Medicare, WIC, Public Housing, etc. *
If yes, please explain
Have you ever been involved with prostitution, drugs, or illegal gambling? *
If yes, please explain
Have you ever claimed to be a United States Citizen? *
If yes, please explain
Have you ever been involved with a terrorist group or espionage? *
If yes, please explain
Have you ever helped anyone enter the United States illegally? *
If yes, please explain
Have you ever used diplomatic immunity? *
If yes, please explain
Have you ever committed domestic violence? *
If yes, please explain
Have you ever been in front of a judge? *
If yes, please explain
Since the first time you entered the U.S. have you ever been arrested? *
If yes, please explain
Do you currently owe any traffic tickets? *
If yes, please explain
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