JFCS Immigration Legal Services Online Intake
*While we remain open and able to provide immigration legal services, our physical office is currently closed to the public. However, we continue to work Monday through Friday, from 9:00 am to 5:00 pm and all appointments will take place virtually until further notice.*

Thank you for your interest in JFCS Immigration Legal Services. Our office is open Monday through Friday from 9:00 am to 5:00 pm. If you or someone you know needs assistance with an immigration issue, please fill out this form.

If you are already a client with JFCS Immigration Legal Services, please contact your representative. If you do not know who your representative is, or if you have any questions about this form, please call our Intake Coordinator at 412-904-5966.

Disclaimer: Completing this form does not mean that your case has been accepted by JFCS Immigration Legal Services. You will be contacted at a later date for an appointment with a representative at JFCS Immigration Legal Services to begin work on your case.

If you are looking for assistance with anything other than immigration legal services, you may visit ISAC Pittsburgh at https://isacpittsburgh.org/referral2019/ to complete their intake form.
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Email *
Legal First Name *
What is your legal first name?
Legal Last Name *
What is your legal last name?
Gender *
How do you identify?
Address Line 1 *
What is your street address? (Example: 5743 Bartlett St)
Address Line 2
What is your apartment, suite, or floor number? (Example: Apartment #29 or Floor 2)
City *
What is your city of residence? (Example: Pittsburgh)
State *
What is your state of residence? (Example: Pennsylvania)
Zip Code *
What is your zip code? (Example: 15217)
Primary Phone *
What is your primary phone number? (Example: 4124227200)
Secondary Phone
What is your secondary phone number? (Example: 4124227200)
Primary Email *
What is your primary email address? (Example: immigrationlegal@jfcspgh.org)
Marital Status *
What is your marital status?
English Level *
What is your English language level?
Country of Origin *
In which country were you born?
Languages *
Which languages do you speak?
Entry Visa *
How did you enter the United States?
Date of Entry *
On which date did you most recently enter the United States? If date is not known, please give your best estimate. DO NOT answer unknown.
Immigration Status *
What is your current immigration status?
Date of Birth *
What is your date of birth?
MM
/
DD
/
YYYY
A# / USCIS#
What is your Alien Registration Number? (You may find your A#/USCIS# on documents such as the I-94, Permanent Resident Card, Employment Authorization Document, and immigration court documents.)
How many people are in your household? *
What is your annual household income? *
Criminal History *
Have you had any interaction with the police in the United States, or have you ever had to speak with a judge?
Required
Criminal History Description
If you answered "Yes" to the Criminal History question, then please explain. (Example: incident date, criminal charges, final outcomes, etc.)
Immigration Help *
What kind of immigration help do you need?
Are there any additional services you need help with?
Referral Information
If you are submitting a referral for this person, please enter your contact information. (Example: Name, organization, phone number, email, etc.)
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