IMMIGRATION LEGAL TEAM – CONSULTATION QUESTIONAIRE
**(PLEASE PRINT)**
Information about the individual attending the Consultation:
Date:___________________________________
Full Name:_______________________________________________________
Date of Birth: ______________
Address:__________________________________________________________________________________
(Street) (Apt. #) (City) (State) (Zip)
Phone (work):_____________Phone (home):_____________E-mail address: _____________________________
Fax (home):_______________________Fax (work): _______________________
Referred to BOGLE & CHANG, LLC by: ________________________________
Brief description of the factual situation leading you to seek a consultation from BOGLE & CHANG:
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Information from the Foreign National: (If person attending the consultation is not the foreign national, please complete the information that youknow concerning the foreign national who is the subject of the consultation)
Is the foreign national in the U.S.? ________ & If so, last date of entry to U.S: _____________________________
Status at time of entry:_____________________(Tourist, Student, Without inspection, etc.)
Expiration date of I-94______________________________________
Immigration Number (As contained on foreign national’s work card, green card or any documents for the UCIS or Court) A#:_____________________________
Social Security Number (if any):_____________________________________________________________________
Other names used:_____________________________________________________________________
Foreign national’s place of birth (city/state/Country):___________________________________________________
Any right to citizenship in country other than country of birth: Yes____ No____Is the foreign national employed by a U.S. employer?
Yes____ No____
If so, name and address of U.S. Employer:______________________________________________________________________________________________
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Please provide the foreign national’s prior periods of stay in the United States and type of visa:
(From) ;(To)
(Type)________________________________________________________________________________________________
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Has the foreign national ever stayed beyond the date on the I-94 Arrival/Departure record?:________________
Has the foreign national ever worked without Citizenship and Immigration Service Permission?: ______________
Marital Status of foreign national (circle one): Single____ Married____ Divorced ____Widowed ____ Civil Union ____
Spouse’s Name:____________________________________________ (Husband or Wife, also give maiden name for wife)
Date of Marriage:______________________Place of Marriage:_________________________________________ (City, State, Province, Country)
Spouse’s Status in the U.S.:__________________________________
Location of Spouse:________________________________________
If spouse is not a U.S. citizen, please provide all prior periods of stay in the United States by spouse of foreign national and type of visa:(From) (To) (Type )
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List children with Date, Place of birth (City, State, Country);
current immigration status if in U.S.:_________________________________________________________________________
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Provide all prior periods of stay in the United States by children and type of visa:(From) (To) (Type )
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(Any children born in U.S.?
If so, please indicate.)____________________________________________________________________________________
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Does the Foreign National have any U.S. Citizen parents or grandparents? Yes____ No
Please provide details if known:_______________________________________________________________________________________________
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Has the foreign national ever appeared before an Immigration Judge?: Yes___ No ___
When:____________ Where:________________________Result:_______________________
Attorney on case:______________________________Phone:______________________________
Previous applications made to USCIS (formerly INS): ______________________________________________________________________________________________________
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Is the foreign national afraid to return to his/her country of Citizenship/Nationality?
Why?_________________________________________________________________________________________________
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Please list any arrests, charges and/or convictions including traffic violations:
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Has the foreign national ever been fingerprinted for any reason, whatsoever?______________
For Yes, Explain circumstances_____________________________________________________________________________
When_______________________Where_____________________________________________________________________
____________________________________________________________________Why______________________________
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I understand that providing this information to BOGLE & CHANG, LLC is for the purpose of obtaining a Consultation and is not intended for the purpose of establishing an attorney client relationship until I have executed a written Legal Services Agreement entering into such a relationship with the BOGLE & CHANG, LLC.
Completed By:________________________________________________________
Signature ___________________________________________________________
PRINT NAME ________________________________________________________
DATE: ________________________________________________________
BOGLE & CHANG, LLC
Phone: (800) 342-1733
Fax: (617) 674-2396
Email to: lawyer@immigrationlegalteam.com