IN-TAKE FORM
IN-TAKE FORM | For assistance download this file: bit.ly/ftspexample
Email address *
Full Name *
Date of Birth *
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Age *
What Country Were You Born In? *
Alien Number *
Address *
Phone Number *
Have you received a removal order? *
If you answered yes, where and when?
Please describe your immigration detention history. Where were you detained and for how long? If you have never been detained by I.C.E please enter N/A. *
When was your last check-in date *
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What is your check-in status? *
When did you arrive to the USA?
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Do you have an immigration attorney? *
If yes, please name your attorney and firm. If you don't have one please enter N/A. *
What is your personal history and grounds for a pardon? *
Case information. Please explain your case. *
Prison Information. Please explain your time in prison and how you made use of your time. *
Immigration Case. *
Explain your life after prison. *
Extraordinary Circumstances. Describe the harms or disadvantage to you, your family, and community that would be caused due to your deportation. Please be specific and detailed as possible. *
Please list all of your prior convictions that need pardoned. *
Date and time of Conviction *
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Sentenced Received.
Did you take a plea deal or go to trial? *
Were you advised of immigration consequences? *
If you were advised of immigration consequences when were you given advice?
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Restitution Paid? *
List any prior convictions that does not need a pardon. If none please enter N/A *
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