Immigrant Applicant initial form
This is the first step in working with the regional center. Please provide all information requested. These include some of the questions and information that will be requested by the Department of Homeland Security for immigration purposes.
First Name *
Last Name *
Current Country citizenship *
Email address (primary contact) *
How can we contact you
Phone number (include country code) *
How may we call you if necessary?
Have you EVER, in or outside the United States knowingly committed any crime of moral turpitude or a drug-related offense for which you have not been arrested? *
Required
Have you EVER, in or outside the United States been arrested, cited, charged, indicted, convicted, fined, or imprisoned for breaking or violating any law or ordinance, excluding traffic violations? *
Required
Have you Ever, in or outside the United States been the beneficiary of a pardon, amnesty, rehabilitation decree, other act of clemency, or similar action? *
Required
Have you EVER, in or outside the United States exercised diplomatic immunity to avoid prosecution in the United States *
Required
Have you received public assistance in the United States from any source, including the U.S. Government or any State, county, city, or municipality (other than emergency medical treatment), or are you likely to receive public assistance in the future? *
Required
Have you EVER within the past 10 years been a prostitute or procured anyone for prostitution, or intend to engage in such activities in the future? *
Required
Have you EVER engaged in any unlawful commercialized vice, including, but not limited to illegal gambling? *
Required
Have you EVER knowingly encouraged, induced, assisted, abetted, or aided any alien to try to enter the United States illegally? *
Required
Have you EVER illicitly trafficked in any controlled substance, or knowingly assisted, abetted or colluded in the illicit trafficking of any controlled substance? *
Required
Have you EVER engaged in, conspired to engage in, or do you intend to engage in, or have you ever solicited membership or funds for, or have you through any means ever assisted or provided any type of material support to any person or organization that has ever engaged or conspired to engage in sabotage, kidnapping, political assassination, hijacking or any other forms of terrorist activity? *
Required
Do you intend to engage in the United States in espionage? *
Required
Do you intend to engage in the United States in any activity a purpose of which is opposition to, or the control or overthrow of, the Government of the United States, by force, violence, or other unlawful means? *
Required
Do you intend to engage in the United States in any activity to violate or evade any law prohibiting the export from the United States of goods, technology, or sensitive information? *
Required
Have you EVER been a member of, or in any way affiliated with, the Communist Party or any other totalitarian party? *
Required
Did you, during the period from March 23, 1933, to May 8, 1945, in association with either the Nazi Government of Germany or any organization or government associated or allied with the Nazi Government of Germany, ever order, incite, assist, or otherwise participate in the persecution of any person because of race, religion, nation origin, or political opinion? *
Required
Have you EVER been deported from the United States, or removed from the United States at government expense, excluded within the past year, or are you now in exclusion, deportation, removal or rescission proceedings? *
Required
Are you under final order of civil penalty for violating section 274C of the Immigration and Nationality Act for the use of fraudulent documents or have you, by fraud or willful misrepresentation of a material fact, ever sought to procure, or procured, a visa, other documentation, entry into the United States, or any immigration benefit? *
Required
Have you EVER left the United States to avoid being drafted into the U.S. Armed Forces? *
Required
Have you EVER been a J nonimmigrant exchange visitor who was subject to the 2-year foreign residence requirement and have not yet complied with that requirement or obtained a waiver? *
Required
Are you now withholding custody of a U.S. citizen child outside the United States from a person granted custody of the child? *
Required
Do you plan to practice polygamy in the United States? *
Required
Have you EVER ordered, incited, called for, committed, assisted, helped with, or otherwise participated in acts involving torture or genocide? *
Required
Have you EVER ordered, incited, called for, committed, assisted, helped with, or otherwise participated in killing any person? *
Required
Have you EVER ordered, incited, called for, committed, assisted, helped with, or otherwise participated in intentionally and severely injuring any person? *
Required
Have you EVER ordered, incited, called for, committed, assisted, helped with, or otherwise participated in engaging in any sexual contact or relations with any person who was being forced or threatened? *
Required
Have you EVER ordered, incited, called for, committed, assisted, helped with, or otherwise participated in limiting or denying any person's ability to exercise religious beliefs? *
Required
Have you EVER served in, been a member of, assisted in, or participated in any military unit, paramilitary unit, police unit, self-defense unit, vigilante unit, rebel group, guerrilla group, militia, or insurgent organization? *
Required
Have you EVER served in any prison, jail, prison camp, detention facility, labor camp or other situation that involved detained persons? *
Required
Have you EVER been a member of, assisted in, participated in any group, unit, organization of any kind in which you or other persons used any type of weapon against any person or threatened to do so? *
Required
Have you EVER assisted or participated in selling or providing weapons to any person who to your knowledge used them against another person, or in transporting weapons to any person who in your knowledge used them against another person? *
Required
Have you EVER received any type of military, paramilitary, or weapons training? *
Do you know of any medical condition that may disqualify you, your spouse, or your children from receiving U.S. immigrant visas? *
Required
Will you be able to clearly document the cash required to make your investment comes from lawful sources? *
Required
Have you EVER been denied on a prior application for a US immigrant or non-immigrant visa? *
Required
Is there any other reason why you may be denied a US visa? *
Required
Have you EVER worked in the United States without permission? *
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