Client Intake Form

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First Name(s): 
Family name: 
Street address: 
Zip code:  
Email address: 
Preferred method of communication:
Person we should call to set up an appointment: 
Phone number(s): 
Is it safe to call or leave voicemails at this number? (yes or no)
Is it safe to send text messages to this phone number? (yes or no)
How did you find out about The Advocates? 
Are you currently working? 
If yes, approximately how much do you make each month? 
Do you currently live with any immediate family members,
including spouse, parent, child, brother/sister?

How many immediate family members do you live with? 
Are they working? 
If yes, how much does your household (all immediate family
members who are working) make each month?
Do either you or your household have any other income sources,
including public assistance, disability, and Social Security?
Other assets, such as a home, car, savings, and approximate value? 
Country of origin: 
Languages spoken: 
What is your English level?


Date of birth: 
Place of birth: 
Education level:

Ethnic group: 
Are you married?
If so, is your spouse in the U.S.?
What is your spouse's immigration status? 
Do you have any children?
If so, how many? 
Are any in the U.S.? 
If so, what is the immigration status of your children in the U.S.? 
Have you ever been represented by another lawyer for your immigration case?
Name of previous lawyer: 
Address of previous lawyer: 
Phone number of previous lawyer: 
Is he/she still representing you?
Why/Why not? 
Do you have a medical or psychological disability?
If yes, please explain: 
What is your A# (If you have not filed for asylum or have not been in contact
with immigration, you may not have an A number.)
Date you last came into the U.S.: 
Place of entry: 
Immigration status/visa at time of entry (Visitor, Student, None, Other): 
Current immigration status, if any: 
I-94 (the white card given to you when you entered the U.S.) expiration date: 
Have you ever been arrested by the immigration authorities in the U.S.?
If yes, please explain: 
Have you filed for asylum in the U.S.?
Have you had an asylum interview?
If yes, interview result: 
Have you ever been to Immigration Court?
Do you have a hearing scheduled in Immigration Court?
Hearing date: 
Are you appealing a decision by an Immigration Court?
Date of decision of Immigration Judge or BIA: 
Why are you afraid to go back to your country? 
Why do you think you would be harmed? 
Who do you fear will harm you or who has harmed you? 
What, if anything, has happened to you and/or your family in the past? 
When did the incident happen? 
What do you think would happen if you did return to your country? 

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