Intake Sheet Online | Scott and Associates

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Alien's information

Alien's Last Name(s): *

First Name: *

Date of Birth: *

Contact information

Email (list ONE): *

Email a copy of this form when complete?: *

Yes

US Phone (for leaving messages): *

US Mailing address (street address, city, state, and zip code): *

Citizenship

Alien's countries of citizenship and lawful permanent residence (list all): *

Miscellaneous Info

Has the alien ever lived for more than six months in any countries other than the US and his/her country of citizenship?: *

Yes

If yes, what countries?:

Has the alien performed military service?: *

Yes

Has the alien ever had a valid passport from his/her home country?: *

Yes

Has the alien been persecuted in his home country due to his religion, ethnic group or political position or do you suspect that the petitioner would be persecuted in the alien's country for those reasons other than merely being American?: *

Yes

Date and Signature

Re-enter the Alien's last name as given in the first question: *

I attest (a) that the above is true to the best of my knowledge, (b) that the Alien has not entered or exited the country except as listed on this form, (c) that the Alien has not been arrested except as listed on this form, (d) that if I discover that the Alien has entries or exits not listed above or arrests not listed above, that I will immediately inform the attorney in writing, and (e) that by entering my name below I am signing this document.

Name of person completing the Intake Sheet: *

Signature date: *