Part I.Contact Information
Name of applicant

Address

City, State or Province, Country, Zip/Postal Code

Date of birth

Place of birth

Nationality/Nationalities

Social Security Number (if any)

Alien Number (if any)

If you are in the United States, please provide the following information:
a. Date of arrival

b. I-94 #

c. Current nonimmigrant status

d. Date current status expires

e. Daytime phone number with area code

Title of your currently held position

Name of the applicant's current employer

Address of the applicant's current employer

Please describe the duties of your present position

Highest level of education:
a. Name of school

b. Major/Subject

c. Degree completed

d. Date the degree was earned

Other relevant experience and education (please attach a CV/Resume). Please provide verification of relevant employment in the U.S. and abroad, including exact dates of hire, job title, job duties, location within organization, number and type of employee(s) supervised.

Please provide names, ages and relationships of accompanying family members
a. Name

b. Age

c. Relationship

Part II. Information about the proposed position

Title of position offered to the applicant
a. Principal owner/investor/trader

b. Manager

c. Supervisor

d. Executive

e. Specialist

f. Other

Description of duties of the position. Please highlight:
a. Managerial or executive functions

b. Special or unique duties

c. Functions that are required to “direct and develop” the investment

d. Minimum requirements to perform the job

Please explain why an American could not perform this position?

Annual U.S. salary and benefit package:
a. Salary

b. Allowances/Benefits

c. Total

Is the applicant filling a new position?
YesNo

Name of person in the U.S. being replaced on this position

If not a replacement, is this an increase of staff?
YesNo

Is the applicant renewing a previous E visa? If so, when and where was the visa issued?

Have you ever worked in the United States without work permission? If so, please explain on a seperate page.

Part III Information About U.S. Enterprise, Business or Company

Type of business enterprise:
a. Corporation

b. Privately owned

c. Branch / Liaison Office/ Agency

d. Joint Venture with an American Individual or Firm

e. Partnership

f. A subsidiary company

g. Other

Address of Headquarters. Please include telephone and fax numbers

Date the enterprise was established

IRS Tax #

Address of Subsidiaries and Branch Offices. Please include telephone and fax numbers

What is the nature of the business?
a. General trades

b. Imports to U.S

c. Exports from U.S.

d. Manufacturing

e. Retail Sales

f. Services /Technology

Please describe fully the services, production, or other activity provided above.

Name and address of foreign parent business. Pease provide telephone and fax number

If the U.S. enterprise is majority-owned by an individual, please provide the following information:
a. Name of principal individual owner

b. Permanent address

c. Percentage of ownership

d. What are the sources of the principal individual owner (in the U.S. and abroad)

What are the amounts of the principal individual owner (in the U.S. and abroad)

e. Please provide the names, nationalities, and percentages of ownership of each of the other individual owners of the U.S. enterprise. If any are Legal Permanent Residents of the United States (“green card” holders), note “LPR” under nationality:

f. What is the percentage of the U.S. enterprise over which the investor has direct operational control? If there is a difference between the percentage of ownership and the percentage of control, please explain.

g. Has the ownership of the U.S. enterprise changed since its establishment? Please indicate:
YesNo
If so, please explain how.

If the U.S. enterprise is majority-owned by a foreign corporation, please provide the following information:
a. Principal corporate owner

b. Total assets in U.S. dollars

c. Date and place of incorporation

d. Percentage of U.S. enterprise owned

e. General nature of parent firm

f. Please list the names, nationality, and percentage of ownership of the principal stockholders of the parent corporation:

If the U.S. enterprise is owned jointly with a U.S. corporation, please list the name and percentage ownership of the U.S. partner:

a. Has the ownership of the U.S. enterprise changed since its establishment? Please indicate:
YesNo
If so, please explain how.

Please provide evidence of the ownership by submitting copies of stock certificates, the joint venture/partnership agreement or other evidence with supporting documents.

Please attach the most recent financial statement for the fiscal or calendar year that includes information about:
a. Total assets of U.S. business, including current cash and historical cost
b. Total liabilities
c. Owner’s equity
d. Total annual operating income

What type are the personnel in the U.S.?
a. Nationals of treaty country:
Managerial/Executive

type of U.S. visa (if any)

Specialized Essentials

type of U.S. visa (if any)

All other employees

type of U.S. visa (if any)

b. U.S. Citizens and Legal Permanent Residents
Managerial/Executive

type of U.S. visa (if any)

Specialized Essentials

type of U.S. visa (if any)

All other employees

c. Other (third country nationals)
Managerial/Executive

type of U.S. visa (if any)

Specialized Essentials

type of U.S. visa (if any)

All other employees

type of U.S. visa (if any)

d. TOTAL:
Managerial/Executive

Specialized Essentials

All other employees

Part IV – Treaty Trader Applicants

Please describe the nature of trade. What goods, monies, or services are traded between the U.S. enterprise and the treaty country?

To answer the following question:
A. For trade in merchandise, exports and imports, please refer to shipment and sale of goods across international boundaries
B. For trade in services and technology, exports and imports, please refer to the sale of services by treaty-county nationals to nationals of the U.S .and other countries

What was the Gross International Trade of the U.S. Enterprise for:
A. Imports from treaty country to U.S. business. Please provide:
the dollar value

number of transactions

percent of total trade

B. Exports from U.S. business to treaty country
the dollar value

number of transactions

percent of total trade

C. Imports from third country to U.S. businesses
the dollar value

number of transactions

percent of total trade

D. Exports from U.S. to third countries
the dollar value

number of transactions

percent of total trade

E. Domestic U.S. production/manufacturing
the dollar value

number of transactions

percent of total trade

Is the information provided in the question above:
a. for the calendar year

b. for the fiscal year

Volume of trade. What is the volume of the U.S. – treaty country trade in non monetary terms? (number of shipments, services rendered that did not result in actual transfer of goods?

Part V – Information About Proposed Investment

If you are an individual investor, please provide the following information:
a. What is your country of residence?

b. What is your immigration status in the U.S

c. What is the percent of your ownership?

Please choose one of the following to describe the type of investment:
a. Creation of a new business. Please describe the business.

b. Purchase of an existing business. Please provide the purchase price

c. Continuation of an existing business

d. Please provide the Fair Market Value of the business

Total investment from abroad made in the United States for the year.
A. Please provide the date and the amount of your initial investment
Amount:

Date:

a. Cash:

b. Inventory:

c. Equipment:

d. Premises:

e. Other(describe):

f. Total:

B. Total cumulative investment:
a. Cash:

b. Inventory:

c. Equipment:

d. Premises:

e. Other(describe):

f. Total:

The information provided above is for
a. for the calendar year

b. for the fiscal year

What were the sources of investment capital (e.g., cash from foreign sources, foreign bank loans, sale of stock or other personal property)? Please provide information regarding how U.S. bank loans have been secured (mortgage debt, commercial loan secured by the assets of the enterprise itself, personal loan secured by applicant’s own assets):
a. Foreign capital investment

b. Foreign bank loans

c. U.S. bank loans

d. U.S. joint venture capitals

e. Personal funds

f. Corporate funds

g. Stocks

h. Debenture

i. Bonds

j. Other (please explain)

If the U.S. enterprise is an investment by a corporation, please provide the following information:
Name of corporation:

Address of corporate headquarter(s)

Total assets:

Date and place of incorporation

Percentage of U.S. enterprise owned

General nature of parent firm

If the U.S. enterprise is a joint venture by a foreign corporation and a U.S. corporation, please provide the following information about the joint corporate owner.
Name of U.S. corporation

Address of corporate headquarters

Percentage of ownership

General nature of parent firm

Part VI – Enterprise Details

Application type (please check one):
a. This petition is based on an investment in a commercial enterprise in a targeted employment area for which the required amount of capital invested has been adjusted downward
YesNo
b. This petition is based on an investment in a commercial enterprise in an area for which the required amount of capital invested has been adjusted upward.
YesNo
c. This petition is based on an investment in a commercial enterprise that is not in either a targeted area or in an upward adjusted area.
YesNo

Employment creation information
Please provide the number of the full –time employees in the enterprise in the U.S. (excluding you, your spouse, sons and daughters) as follow:
a. When you made your initial investment

b. Now

c. Difference

d. How many of these new jobs were created by your investment?

e. How many additional new jobs will be created by your additional investment?

Investor Visa Checklist

INFORMATION ABOUT U.S. OPERATIONS

Copies of passports of majority shareholders from treaty country
Articles of Incorporation and certificate from state
Bylaws
Stock certificates
Certificate of Officers
Business license
Certificate of Qualification of Foreign Business
Partnership agreement or Joint Venture agreement
Receipts for equipment, supplies
Bank account statements showing capitalization
Loan agreements, if any
Copies of advertisements, press releases, etc., about new office
Trade references
Licenses, if required for type of business or profession
Copies of telephone bills re: international calls to treaty country
Sample contracts with customers/clients; invoices re transactions
Letters of credit
Business plan re: projected revenues, costs, staffing
Letters from chambers of commerce, trade commissioners, home office re amount of initial investment as “substantial” and reasonable for start up of this type of business
Lease or deed to office/facility space
Trade or professional association memberships
Awards, certificates
PR releases
Marketing brochures/firm résumé
Photos of facilities, products, etc.
Organizational chart re: employees; projected organization
Customer/supplier list
Relevant patents, trademarks, copyrights, if any
Statistics re: volume and amount of trade between U.S. and treaty country (past performance and projected)

INFORMATION ABOUT RELATED OPERATIONS ABROAD

[Same as above]
Recent annual report, and/or tax return

INFORMATION ABOUT PROPOSED POSITION

Job description (Highlight managerial or executive functions or special or unique duties or those functions that are required to “direct and develop” the investment.)
Minimum requirements to perform the job
Why could an American not do this position?

INFORMATION ABOUT APPLICANT

CV/Resume
Copies of diplomas, degrees and relevant transcripts
Verification of relevant employment in U.S. and abroad: Exact dates of hire; job title, job duties, location within organization, number, type of employees supervised. Optional: information about employer, recommendation about alien’s performance.
Membership in trade or professional societies
Articles written about or by alien
Awards or commendations received
Number and type of employees supervised before and in future

GENERAL INFORMATION

All documents in a foreign language must be translated. The translator must certify under oath that the translator is competent to translate into English. Notarized translations are preferred.

Referral Source
How did you find our website?*

Your Questions or Comments

Your privacy is important to us! By clicking the Submit button, you acknowledge that we collect the information you provide in this form only to assess your options for immigration. We will not sell your information to third-parties or disclose it without your consent unless authorized by law or if you hire us as your attorney and the services we provide for you require us to give your information to third-parties. You also acknowledge that an attorney-client relationship is not established until you speak directly with the attorney in person or over the phone to confirm such relationship.

PART A. U.S. IMMIGRATION ISSUES

What immigration Services do you Require?
Spousal sponsorshipFamily SponsorshipSelf PetitionAdjustment of StatusWork VisaStudent VisaInvestor VisaTravel Document / Advance ParoleEmployment Authorization CardCitizenshipAsylumOther
If “Other”, please provide type of service required

PART. B PERSONAL INFORMATION

First Name

Middle Name

Family Name

Other name used (including maiden name)

Date of Birth
Date

Month

Year

Nationality

Citizenship (country)

Place of birth
Town

Province/State

Country

Phone number

Email

Age

Salutation
MrMrsOther
U.S. Social Security no.

Home phone

Business phone

E-mail address

Fax number

Cell/Alternative phone

Current residence address

Address in the United States where you will reside (if not currently in the U.S.)

Present occupation
EmployedStudentRetiredUnemployedOther
If “other” please explain
PART C. PLEASE COMPLETE IF YOU ARE CURRENTLY OUTSIDE OF THE U.S. (if not applicable skip this part)

Full name, address and phone number(s) of contact person or organization in the U.S

List all countries you have entered in the last 10 years (give the year of each visit)

List all countries that ever issued you a passport:

Have you ever lost a passport or had one stolen?

List all Professional, Social and Charitable Organizations to which you belong(ed) or contribute(ed) or with which you work(ed):

Do you have any specialized skills or training, including firearms, explosives, nuclear, biological, or chemical experience?
If yes then please explain

Have you ever performed military service?
If "Yes" please list: Country, Branch of Service, Rank, Position, Military Specialty, Dates of Service

Have you ever been in an armed conflict, either as a participant or victim?
If "Yes" please explain:

Have you ever been a victim to domestic or other physical/mental abuse?
If "Yes" please provide complete details, including dates of arrests, etc:

How long do you intend to stay in the United States?

Have you ever been refused a U.S. Visa?

If Yes:
When

Where

What type of visa

Have you ever been issued a U.S. Visa?

If Yes:
When

Where

What type of visa

Have you ever been in the United States?

If Yes:
When

For how long

Do you intend to work in the United States?

Do you intend to study in the United States?

Has your U.S. Visa ever been canceled or revoked?

Have you ever been refused admission to the United States?

Has anyone ever filed an immigrant visa petition on your behalf?

If answered "Yes" to the three questions above, please explain below:

Are any of the following persons in the U.S., or do they have U.S. Legal Permanent Residence or U.S. Citizenship (please indicate that person's status in the U.S.: i.e., U.S. legal permanent resident, U.S. citizen, visiting, studying, working, etc.)?
Husband / Wife
YesNo
Status

Fiancé / Fiancée
YesNo
Status

Father / Mother
YesNo
Status

Son / Daughter
YesNo
Status

Brother / Sister
YesNo
Status

Have you attended a U.S. public elementary school on student (F) status or a public secondary school after November 30, 1996 without reimbursing the school?

Have you ever been afflicted with a communicable disease of public health significance or a dangerous physical or mental disorder?

PART D. SPONSOR OR PETITIONER (if not applicable skip this part)

Please complete this part if you are a Sponsor or Petitioner of a person seeking immigration benefits.
I am sponsoring
HusbandWifeParentBrotherSisterChild
Are you related by adoption?

Has your relative ever been to the United States?

Is your relative currently in the United States?

Are you applying for an advance parole document for a person who is outside the U.S.?

Will your relative apply for adjustment of status?

Address in the U.S. where your relative intends to live:

If you are a U.S. citizen, how did you acquire your citizenship (birth in the U.S., Naturalization, parents)?

Have you obtained a certificate of citizenship in your name?

Certificate number

Date, Place of issuance

If you are a lawful permanent resident alien, complete the following:
Date

Place of Adjustment of Status

How did you gain permanent resident status (Marriage to a U.S. citizen or lawful permanent resident, through adoption)?

If filing for your husband or wife, provide last address at which you lived together:
Street Address

Unit Number

City

state/province

Zip

Country

From (month/year)

To (month/year)

Have you ever filed a petition for any foreign national before?

If you answered "Yes" to the above question provide the following:
Name

Place

Date

Date of filing

Results

Are you, or any person you are sponsoring, now in exclusion, deportation, removal or recission proceedings?

If "Yes" Name of DHS office:

If you applying for an advance parole document (permission to travel to the U.S.) for a person who is outside the United States, provide the following information about this person:
Current legal name (as shown on the passport or I-94 departure card):

First name

Middle name

Family name

Date of Birth
Month

Day

Year

Country

Citizenship

Current address

Date of intended departure

Expected length of trip

PART E. FAMILY INFORMATION

Name of Father
First Name

Middle Name

Last Name

Father's date of birth
Month

Day

Year

Father’s place of birth
Town

Province/State

Country

Father’s current residence address:

Is Father deceased?

If yes, what year?

Name of Mother
First Name

Middle Name

Family Name

Maiden Name

Mother’s date of birth
Month

Day

Year

Mother's place of birth
Town

Province/State

Country

Mother’s current residence address

Is Mother deceased?

If yes, what year?

Were any of your grandparents born in the United States?

If yes, where?

PART F. MARITAL INFORMATION

Marital status
MarriedWidowDivorceSeparatedSingle
Date of present marriage

Number of times of married, including this marriage

Spouse’s name
First Name

Middle Name

Last Name

Spouse’s date of birth
Month

Day

Year

Spouse’s place of birth
Town

Province/State

Country

Nationality

Citizenship (country)

Spouse’s U.S. Social Security Number

Place of present marriage

Former Spouse
First Name

Middle Name

Last Name

Former spouse’s date of birth
Month

Day

Year

Former spouse’s citizenship

Date/Place of termination of marriage or death

List any children, including stepchildren immigrating with you

a. Child Name

b. Relationship

c. Date of birth

d. Place of birth
City

State

Country

e. Address (if different)

f. U.S. Social Security Number

g. “A” number (if applicable)

PART G. PRIOR RESIDENCE

Residences last 5 years (Present address first)
Street Address

unit number

City

state/province

Zip

Country

From

To

Last residence outside U.S. of more than one year
Street Address

unit number

City

state/province

Zip

Country

From

To

PART H. EMPLOYMENT

Current occupation:

Employment last five years. Present employment first.

Name

Address

Telephone number

Supervisor’s Name

From

To

Current Employer’s Tax Identification Number

If you are applying for Employment Authorization Document, complete the following:
Have you ever before applied for Employment Authorization Document?
If "Yes", Which USCIS Office

Dates

Results

From

To

Currently I am applying for permission to accept employment:
YesNo
Currently I am applying for replacement of lost Employment Authorization Document:
YesNo
Currently I am applying for renewal of my permission to accept employment:
YesNo
If applying for work visa complete the following
Name and address of (prospective) employer:

List all jobs held during the last three years. Also, list any other jobs related to the occupation for which you are seeking a work visa (use attachment if necessary):
a. Name and address of employer

Name of job

Kind of business

b. Date started and left (month/year)
Date Started

Date Left

c. Describe in detail the duties performed, including the use of tools, machines or equipment:

PART I. EDUCATION

High school?

College

Degree earned and date earned:

If applying for a work visa or you are currently outside of the United States please complete the detailed information below
Names of schools, colleges and universities attended

Addresses of schools, colleges and universities attended

Addresses of schools, colleges and universities attended

A. Field of Study:

B. Dates of attendance (month/year)

C. Degrees or Certificates Received

PART J. ARRIVAL INFORMATION

Date of first arrival in U.S.:

Place of first arrival in the U.S.

Date and place of last arrival in U.S.:
A. Date

B. Place

Has a prior visa petition ever been filed?
If yes, answer the following.

A. Where?

B. When?

C. Inspected? Without Inspection?

Means of travel into U.S.:

Status at entry (visitor, student, etc.):

Approved?

Passport Number:

Passport Issue Date

Passport expiry date:

Passport Issue Place:

PART K. DESTINATION IN U.S. AT TIME OF ADMISSION:

Consulate Where Visa Issued:

Visa Validity Dates (month/year)

Visa Number

Visa Classification:

I-94 issue date:

Name Exactly as it Appears on I-94:

Have you ever filed for Permanent Residence in the U.S.?

If yes, please answer the following
A. Date and place of filing:

B, “A” Number as it appears on Lawful Permanent Residence Card:

C. Current Status in the U.S.
U.S permanent residentU.S. refugee/asylee statusPermanent resident as a direct result of refugee/asylee statusStudentTemporary Foreign WorkerK-1 Fiancee VisaBusiness VisitorTemporary Protected StatusOther (please provide)
Information about your proposed travel (if applicable):
Date of intended departure FROM THE U.S. (month, day, year):

Expected length of trip:

How many trips do you intend to use the travel document:

Have you ever before been issued a reentry permit or refugee travel document?

If “Yes” Date Issued (month, day, year):

Disposition (lost, stolen, other):
Since becoming a permanent resident of the United States (or during the past five years, whichever is less) how much total time have you spent outside the United States:

Since you became a permanent resident of the United States, have you ever filed a federal income tax return as a nonresident, or failed to file a federal tax return because you consider(ed) yourself to be a nonresident?

If “Yes” please explain:

Where do you want this travel document sent
Number and Street

Apt. #

City

State or Province

Zip/Postal Code

Country

Daytime Telephone # with area/country code):

PART L. BACKGROUND INFORMATION

List ALL present/past membership in groups of any kind:

Group name

Location (City/State)

Received public assistance in U.S. from any source, or likely to in the future?

Engaged in prostitution in past 10 years, or likely to in future?

Encouraged any alien to enter U.S. illegally?

Trafficked in any controlled substance?

Been in any way involved in any terrorist activity?

Engaged in espionage or intend to once in the U.S.?

Been a member of or affiliated with the Communist Party or Nazi government of Germany between March 23, 1933 and May 8, 1945?

Engaged in genocide or persecuted any person because of race, religion, national origin or political opinion?

Been deported, removed, or excluded from the U.S. or been ordered to do same?

Committed fraud in order to obtain entry into the U.S.?

Left the U.S. to avoid being drafted into the U.S. Army?

Been a J nonimmigrant visitor and not complied with the 2-year foreign requirement or obtained a waiver?

Withheld custody of a U.S. citizen child from a person granted custody of the child?

Been a polygamist or plan to practice polygamy in the U.S.?

Claimed to be a U.S. citizen (in writing or any other way)?

Violated or evaded laws prohibiting the export of goods, technology or information from the Unites States?

If you answered YES to any of the above, explain fully
Have you ever been under immigration proceedings?

If you answered "Yes" to the last question, please explain:
RemovalDetentionExclusionRecisionVoluntary Departure
Withdrawal of Application for Admission
What date did you return to your home country?

Part M. NATURALIZATION APPLICANTS ONLY (if not applicable, skip to Part N)

How many total days did you spend outside of the United States during the past 5 years?

How many trips of more than 24 hours have you taken outside of the U.S. during the past 5 years?

List below all the trips of 24 hours or more that you have taken outside of the United States since becoming a Lawful Permanent Resident. Begin with your most recent trip.
Date left and returned to the U.S. (month/year)

PART N. ADDITIONAL QUESTIONS

Please list all countries you have travelled to and when

Have you ever voted in any Federal, state, or local election in the United States?

Have you ever registered to vote in any Federal, state, or local election in the U.S.?

Since becoming a Lawful Permanent Resident (Green Card holder), have you ever failed to file a required Federal, state, or local tax return or called yourself a “nonresident” on same?

Do you owe any Federal, state, or local taxes that are overdue?

Do you have any title of nobility in any foreign country?

Have you ever been arrested, cited, or detained by any law enforcement officer (including INS, now BCIS and military officers) for any reason?

Have you ever been placed in an alternative sentencing or rehabilitative program (for example: diversion, deferred prosecution, withheld adjudication, deferred adjudication)?

*PLEASE NOTE: If you answered “Yes” to the previous question, but did NOT register with the Selective Service System and you are still under 26 years of age, you must register before you apply for naturalization. If you answered “YES” to the previous question, but did NOT register with the Selective Service System, and you are now 26 years or older, attach a statement explaining why you did not register.

Other, please specify:

Please upload the following documents:

• Passport
• Proof of U.S. citizenship or U.S. Permanent Residency
• Visa (all prior visas to the U.S.)
• Front and back of your I-94 card
• Copy of I-797 Approval Notices
• Employment authorization documents
• Advance Parole documents
• Resume
• Degrees, transcripts and translations
• Birth certificates, and translations (all family members)
• Adoption papers (for dependents if applicable)
• Marriage certificates and/or divorce decrees (candidate and spouse)
• Death certificate (if widowed)

Contact Information

Referral Source
How did you find our website?*

Your Questions or Comments

Your privacy is important to us! By clicking the Submit button, you acknowledge that we collect the information you provide in this form only to assess your options for immigration. We will not sell your information to third-parties or disclose it without your consent unless authorized by law or if you hire us as your attorney and the services we provide for you require us to give your information to third-parties. You also acknowledge that an attorney-client relationship is not established until you speak directly with the attorney in person or over the phone to confirm such relationship.

• If unknown – write “unknown”
• If not applicable – write “N/A”
• If none – write “none”
BENEFICIARY PERSONAL INFORMATION
Full Name (First, Middle Last)

US Social Security Number

Any other names used (please include names by previous marriages)

Place of birth (city/country)

Date of Birth

Date of Entry into the U.S.

Type of Entry Visa into the U.S.

Expiry date of visa

MARITAL HISTORY
Spouse’s Full Name (First, Middle Last)

US Social Security Number

Any other names used (please include names by previous marriages)

Spouse’s place of birth (city/country)

Spouse’s date of birth

FAMILY HISTORY

Father's Full Name

Father's Date of Birth

Father's City and Country of Birth

Father's City and Country of Residence

Mother's Full Name

Mother's Maiden Name

Mother's Date of Birth

Mother's City and Country of Birth

Mother's City and Country of Residence

MARITAL HISTORY
Full name of any former Husband or Wife (if none so state). Please include maiden names if any.

Date of Birth

Date and Place of Marriage

Date and Place of Termination of Marriage

RESIDENCE HISTORY
Street Name and Number

City

State or Province

Country

Dates of Residency (mm/dd/yyyy – mm/dd/yyyy)

Please provide your most recent foreign address of more than one (1) year
Street Name and Number

City

State or Province

Country

Dates of Residency

Please list all employment for the last five (5) years. If none, so state.
Employer Name

Job Title

City

State or Province

Country

Dates of Employment

Please list your Last Occupation Abroad
Employer Name

Job Title

City

State or Province

Country

Dates of Employment

PLEASE ANSWER THE FOLLOWING QUESTIONS

Have you EVER had any problem entering the U.S., obtaining a U.S. visa, or ANY contact with the police in any country?

Have you ever been under immigration proceedings?

If you have children, even adult children, please provide a list of their names, dates of birth, and countries of birth.

What is your current address abroad, if any?

CONTACT INFORMATION

Referral Source
How did you find our website?*

Your Questions or Comments

Your privacy is important to us! By clicking the Submit button, you acknowledge that we collect the information you provide in this form only to assess your options for immigration. We will not sell your information to third-parties or disclose it without your consent unless authorized by law or if you hire us as your attorney and the services we provide for you require us to give your information to third-parties. You also acknowledge that an attorney-client relationship is not established until you speak directly with the attorney in person or over the phone to confirm such relationship.