Petitioner Intake

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Current Name

First Name Middle Name Last Name

Petitioner Other Names

Provide all other legal names, nicknames, aliases, and assumed names.

Contact Information

Email Telephone

US Mailing Address

In Care Of Name Street Address Apt / Ste / Flr Number City State ZIP Code Mailing address is the same as current physical address

Current Address

Select a country to continue address entry.

Country

Street Address Apt / Ste / Flr Number City State ZIP Code Province Postal Code

From Date To Date I have lived at this address for more than 5 years

Prior Addresses

Provide your prior address(es) for the last 5 years.

Describe Yourself

Sex Ethnicity Race Height (ft) Height (in) Weight (lbs) Eye Color Hair Color

Financial Information

Expected Annual Income Filed Taxes for the Last 3 Years Are You a Member of the U.S. Armed Forces or Coast Guard?

Current Employment

Current Employment Status

Employer Name Occupation Country

Employer Street Address Apt / Ste / Flr Number City State ZIP Province Postal Code

Employment Start Date To Date

Other Employment

Provide ALL of your employment history for the last 5 years.

Birth Information

Date of Birth

City of Birth Country of Birth

Country of Citizenship Country of Domicile

Identification Numbers

Social Security Number

USCIS Online Account Number I do not have an Online Account Number

A-Number I do not have an A-Number

Current Status

Citizenship Acquired By

Did petitioner obtain LPR status through marriage?

US Citizenship Information

I have a Certificate of Naturalization Naturalization Certificate Number Naturalization Issue Date Naturalization Issue - City Naturalization Issue - State

Lawful Permanent Resident Information

LPR Class of Admission LPR Date of Admission LPR Place of Admission - City LPR Place of Admission - State

Marital Status

Petitioner Marital Status How many times has petitioner been married?

Current Marriage

Current Spouse Legal Name

Current Spouse First Name Current Spouse Middle Name Current Spouse Last Name

Marriage Information

Date of Marriage Country of Marriage City of Marriage State of Marriage Province of Marriage

Prior Marriage

Father Information

Legal Name

Father First Name Father Middle Name Father Last Name

Father Date of Birth Father Country of Birth Father is deceased

Father City of Residence Father Country of Residence

Mother Information

Legal Name

Mother First Name Mother Middle Name Mother Last Name

Mother Date of Birth Mother Country of Birth Mother is deceased

Mother City of Residence Mother Country of Residence

Other Petitions

Have You Previously Filed an Immigration Petition for Anyone?

Previous Immigration Petitions

Are You Filing Concurrent Petitions for Other Relatives?

Concurrent Relative Petitions

For Attorney/Paralegal

I have attached my last 3 years of tax returns Most Recent Tax Year Most Recent Adjusted Gross Income Second Most Recent Tax Year Second Most Recent Adjusted Gross Income Third Most Recent Tax Year Third Most Recent Adjusted Gross Income

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