Any information obtained from this questionnaire will be kept completely confidential. INFORMATION REGARDING THE APPLICANT (i.e. the person seeking the immigration benefit): Name * First Name Last Name Email * Sex * Male Female Date of Birth MM DD YYYY Phone Number * (###) ### #### Current Address Address 1 Address 2 City State/Province Zip/Postal Code Country Country of Birth Citizenship(s) Have you ever been arrested inside or outside the United States? If so, please explain when, where, and what the outcome was. VISA INFORMATION Are you currently in the United States? * If yes, please answer the following questions. If no, please skip to the next section. Yes No If you are currently in the U.S., what is your immigration status? What visa category did you enter the U.S. with (i.e. Visa Waiver, B-1/B-2, F-1, H-1B, L-1, O-1, Lawful Permanent Resident, Entered Without Documentation, etc.) If you are currently in the U.S., what was the date of your most recent arrival? MM DD YYYY If you are currently in the U.S., what is the date your I-94 status expires? Please visit http://i94.cbp.dhs.gov to obtain your I-94 information. MM DD YYYY Please describe any questions you may have received by Customs and Border Protection upon your entry into the United States. Please provide, to the best of your knowledge, all other times you have entered the U.S. From (month/day/year) - To (month/day/year) EDUCATION Please provide a list of all of your degrees/fields, date you graduated (month/year), and name of school you attended EMPLOYMENT Name of current employer Present Occupation SPONSORSHIP Do you have a family member or employer who is willing to sponsor you for an immigration benefit? If so, please provide the family member's full name and relationship to you, or provide the company's name and the full name of the company representative, job title, email, and phone number for the person who will be responsible for arranging your visa sponsorship. Are you currently facing any immigration deadlines (i.e. need to respond to an RFE or denial; your visa/I-94 status is expiring; court dates; aging out for benefits; etc.)? If so, please explain and include any deadline dates. Is there any additional information you would like to provide on your situation? Thank you!
