A Tradition of Fine Lawyering

IMMIGRATION, CRIMINAL DEFENSE, FAMILY LAW & DIVORCE, ESTATE PLANNING

VINCENT P. MARTIN ZACHARY AAKER MARIA TRAFTON ROBERT A. YARD* MAURY D. BEAULIER*

AYAN AHMED: LEGAL ASSISTANT SARA KETTERING: PARALEGAL CYNTHIA HERMES: OFFICE ASSISTANT *OF COUNSEL

GENERAL IMMIGRATION QUESTIONNARE

Date: ______Conflicts:______Initials:______

Name: ______

Address (complete – street address, apartment number, city, state and zip code):

______

Contact Number: ______

E-Mail: ______

Would you like to receive our Immigration Newsletter regarding the latest immigration news? YES NO

Date of Birth: ______Place of Birth: ______

Occupation: ______Employer Name: ______

Employer Address: ______

Spouse/Fiancé(e) Name (if applicable): ______Spouse’s/Fiance(e)’s date of birth:______

Spouse’s/Fiancé(e)’s country of residence/citizenship (if applicable):______

When did you arrive in the United States? ______

Do you have legal immigration status in the United States?...... YES NO

If yes, what status? ______

Did you enter the U.S. legally?...... YES NO

Have you ever been sent back to your home country or ordered to leave

the United States by any U.S. government official?...... YES NO

Do you have a parent or grandparent who is/was a United States Citizen or

Legal Permanent Resident?...... YES NO

Since your arrival in the United States, have you worked?...... YES NO

Have you (or has anyone else) ever submitted an application or petition of any kind

to U.S. Immigration to help you, your spouse, an ex-spouse, or any of your children

to get legal immigration status in this country?...... YES NO

Have you ever been married?...... YES NO

If yes, what is his/her immigration status? ______

Have you ever been accused of a crime or offense and/or arrested anywhere in the world?...... YES NO

If this is a marriage based case, do you have questions about a Prenuptial Agreement?...... YES NO

Do you have any questions about divorce or criminal defense?...... YES NO

Have you spoken with another attorney regarding your case?...... YES NO

Have you hired another attorney?...... YES NO
U-Visa eligibility - have you been the victim of a crime?...... YES NO

Briefly explain the reason you are here today: ______

______

How were you referred to our office? ______Provide website if found online:______

_____ Initial Here – The consultation fee is $60.00. I understand that this initial consultation does not create an attorney/client relationship. I understand that Cundy and Martin, LLC is not my attorney and that I should not rely on any information from this initial consultation as legal advice. All information provided is confidential.

DEFERRED ACTION FOR CHILDHOOD ARRIVALS (DACA)

Did you enter the U.S. before your 16th birthday?...... YES/NO

Were you under the age of 31 as of June 15, 2012…………………………….…YES/NO

Have you continuously resided in the U.S. since June 15, 2007 up to

the present time? ………………………………………………………………… YES/NO

Had no lawful status on June 15, 2012?...... YES/NO

Are you currently in school, have you graduated or obtained a certificate

of completion from high school, have you obtained a general

education development (GED) certificate, or are you an honorably

discharged veteran of the Coast Guard or Armed Forces of the

United States?...... ……………………………….. YES/NO

Have you been convicted of a felony, significant misdemeanor,

or three or more other misdemeanors, and do not otherwise pose

a threat to national security or public safety?...... YES/NO

______