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
to complete their intake form.
Sign in to Google
to save your progress.
Legal First Name
What is your legal first name?
Legal Last Name
What is your legal last name?
How do you identify?
Prefer not to say
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)
What is your city of residence? (Example: Pittsburgh)
What is your state of residence? (Example: Pennsylvania)
Northern Mariana Islands
U.S. Virgin Islands
Other U.S. Territory
What is your zip code? (Example: 15217)
What is your primary phone number? (Example: 4124227200)
What is your secondary phone number? (Example: 4124227200)
What is your primary email address? (Example:
What is your marital status?
What is your English language level?
Country of Origin
In which country were you born?
Which languages do you speak?
How did you enter the United States?
Born in 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.
What is your current immigration status?
Temporary Protected Status
Legal Permanent Resident
Date of Birth
What is your date of birth?
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?
More than 10
What is your annual household income?
$0 to $10,000 per year
$10,001 to $20,000 per year
$20,001 to $30,000 per year
$30,001 to $40,000 per year
$40,001 to $50,000 per year
$50,001 to $60,000 per year
$60,001 to $70,000 per year
$70,001 to $80,000 per year
$80,001 to $90,000 per year
$90,001 to $100,000 per year
More than $100,001 per year
Have you had any interaction with the police in the United States, or have you ever had to speak with a judge?
Criminal History Description
If you answered "Yes" to the Criminal History question, then please explain. (Example: incident date, criminal charges, final outcomes, etc.)
What kind of immigration help do you need?
Are there any additional services you need help with?
If you are submitting a referral for this person, please enter your contact information. (Example: Name, organization, phone number, email, etc.)
Send me a copy of my responses.
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