Please download, complete and submit your questionnaire form then email it or
scroll down to complete and submit a questionnaire on this page.

CONFIDENTIAL *FOR INTERNAL USE ONLY*

Fields with an* are required and must be filled out.

I. INFORMATION REGARDING THE IMMIGRANT/APPLICANT/BENEFICIARY

(maiden, religious, professional, nicknames)
Gender(Required)
MM slash DD slash YYYY
Place of Birth:(Required)
US Address(Required)
May we send mail to this address?(Required)
Do you have voicemail set up on your phone?(Required)
May we leave you detailed voicemails about your case?(Required)
May we send you emails?(Required)
Foreign Address
Is this your first consultation with our office?(Required)

If you are in the U.S. complete the following

Are you currently employed in the U.S.?
MM slash DD slash YYYY
Did you enter the U.S. without legal documentation?
MM slash DD slash YYYY
Place of Entry
(airplane), (vehicle), (boat), (by foot)
Information about your entry(ies) beginning with your first entry into U.S.
Click the "+" icon to add a new row.
Date of Entry
Place of Entry
Status at Entry
Date of Departure from U.S.
 
Are either of your parents U.S. Citizens?

II. MARITAL INFORMATION

If married, list the name of your Spouse
MM slash DD slash YYYY
Place of birth
MM slash DD slash YYYY
Indicate the legal status of your spouse or partner

Have you been previously married?
If yes, indicate legal status of former spouse/partner

Do you have a parent, spouse or child in active duty or veteran of the U.S Armed Forces?
If your spouse is currently living abroad will your spouse accompany, you to the U.S.?

III. QUESTIONS RELATED TO IMMIGRATION

Have you faced persecution in your country?
Has a U.S. citizen or permanent resident ever filed a family-based visa petition for you?
Has a family-based visa petition ever been filed for your parents when you were under 21 years of age?
Have you, your spouse, child, or parent been victim(s) of a violent crime within the U.S.?
If yes, was a police report filed?
Do you have a copy of the police report?
Have you been victim of domestic violence inside or outside the U.S.?
If yes, indicate the legal status of your spouse, former spouse, partner, or ex-partner

Have you ever been forced to work without pay?
Have you ever been forced to work to pay off a debt?
Have you ever been forced to have sex or perform sexual acts?
Have you or any of your immediate family members been victim(s) of human trafficking?

IV. GROUNDS OF EXCLUSION

Have you ever entered the U.S. without legal permission?
Did you present any false documents to enter the United States? (For example: a false passport, green card, birth certificate)
Have you ever claimed to be a U.S. Citizen or unlawfully voted in a U. S. election?
Have you ever been detained by U.S. immigration officials or attended a U.S. court hearing?
Date(s) of detention or court hearing
Click the "+" icon to add a new row.
Do you currently have a hearing at an immigration court?
MM slash DD slash YYYY
Have you ever been arrested or detained by the police in any country in the world, including the US?
Date(s) of detention or arrest
Click the "+" icon to add a new row.
Reason(s)
Date(s)
 
Have you ever helped, supported, or paid for another person to enter the U.S. unlawfully (including your own children/family members)?
Criminal History (including traffic violations)
Click the "+" icon to add a new row.
Date
Reason
Location
Outcome or Disposition
 
Criminal History (including traffic violations)
Click the "+" icon to add a new row.
Date
Reason
Location
Outcome or Disposition
 

V. LIST YOUR PARENTS & CHILDREN (INCLUDING STEP-CHILDREN)

Click the "+" icon to add a new row.
Click the "+" icon to add a new row.
Name (First, Last)
Relationship
Date of Birth
City, State/Province, Country of Birth
Are They Applying with You?
Immigration Status
 

VI. SOCIAL MEDIA ACCOUNTS

Important Information About Legal Representation

Completing this questionnaire and having a consultation with an attorney do not guarantee legal representation. The attorneys at Martinez Immigration Law do not represent you until you have had a consultation with an attorney, the attorney agrees to take your case, and you sign a contract that explains the legal services to be provided.
Consent(Required)