DACA Pre-Screening Intake Form
Due to a federal court order, USCIS has resumed accepting both initial and renewal requests for deferred action under DACA, including initial requests from individuals who have never before been granted deferred action under DACA. Until further notice, and unless otherwise provided in this guidance, the DACA policy will be operated on the terms in place before it was rescinded on Sept. 5, 2017. Please fill out this entire form to help us determine whether or not you can potentially qualify as a DACA recipient. Thank you.
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Today's Date: *
Datum
Full Name: *
Street Address (including unit number if applicable): *
City, State, Zip Code, County: *
Telephone Number: *
E-Mail: *
Gender: *
Birth Date: *
Datum
Number of Children: *
Marital Status: *
Generation: *
Race/Ethnicity (check all that apply): *
Pflichtfrage
Do you have a Disability? (if so, please specify) *
Highest Level of Education *
What is your current Employment Status? *
Do you currently have Health Insurance? *
What is your Yearly Household Income? *
What do you report for tax purposes as your Total Household? *
Country of Origin: *
What Year did you begin living in the U.S.? *
How many Years have you consistently lived in the U.S.? *
What is your English-Speaking Ability? *
Referral Source: *
Pflichtfrage
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