Safe Havens

Basic Immigration Status Questionnaire

Purpose: To obtain the facts necessary for an immigration lawyer to determine immigration consequences of a criminal conviction. 

Documents: Xerox any immigration documents/passport.

Criminal History: Rap sheets and possible current plea-bargain offenses needed before calling.

_____________________________       ________________           

Client's Name                                              Date of Interview   

Immigration Hold:  YES    NO

___________________________    (_____)____________              ______________

Client's Immigration Lawyer          Telephone Number         Def's DOBirth

1.  Entry: Date first entered U.S.? ________________Visa Type:_____________

     Significant departures: Date: _________________  Length: ______________

     Purpose: _________________

     Date last entered U.S.?  _______________   Visa Type: __________________

2.  Immigration Status: Lawful permanent resident?  YES     NO

     If so, date client obtained green card?  _______________

     Other special immigration status: (refugee), (asylee), (temp. resident),

 (work permit), (TPS), (Family Unity), (ABC), (undocumented),

 (visa - type:________________) Date obtained? _____________

 Did anyone ever file a visa petition for you?  YES NO

 Name and #:________________________________  Date? ____________

 Type of visa petition? __________________  Was it granted? YES        NO

3.  Prior Deportations: Ever been deported or gone before an immigration judge?  YES  NO    Date? _____________________________________

      Reason? ______________________________________________________

Do you have an immigration court date pending? YES                   NO

Reason? _______________________________  Date?__________________________________

4.  Prior Immigration Relief:  Ever before received a waiver of deportability [§ 212(c) relief or cancellation of removal] or suspension of deportation?  YES       NO     

      Which:______________          Date: ____________

5.  Relatives with Status: Do you have a U.S. citizen relative: (parent), (spouse), (child -- DOB(s) _________________________________), (brother) or (sister)? 

Do you have a lawful permanent resident (spouse) or (parent)?  ________________________________________________________

6.  Employment: Would your employer help you immigrate? YES    NO

Occupation:______________________

Employer's name and number:____________________________________

7.  Possible Unknown U.S. Citizenship: Were your or your spouse's parent or grandparent born in the U.S. or granted U.S. citizenship?  YES           NO  Were you a permanent resident under the age of 18 when a parent naturalized to U.S. citizenship?         YES    NO

8.  Have you been abused by your spouse or parents?           YES    NO

9.      In what country were you born?  _________________

      Would you have any fear about returning?   YES                NO

      Why? ___________________________________________________