Survey - Immigration Legal Services Client Survey (English) - Catholic Charities of Eastern Oklahoma

Posted on August 27, 2024 Posted By: dcrowley Categories:

Immigration Legal Services Client Survey

Immigration Intake Form - English Version

Welcome! Thank you for contacting Catholic Charities of Eastern of Oklahoma. This intake form is designed to help us understand your situation better so we can assist you more effectively. Here, you'll provide us with essential information about the beneficiary and their intentions for applying to an immigration benefit. (Please note, "beneficiary" refers to the noncitizen individual seeking an immigration benefit. For example, if a US Citizen spouse requests a benefit for their foreign national spouse, the foreign national spouse is the "beneficiary".) The answers provided in this form are private and we will not and cannot share them with the Government or any other person without the beneficiary's permission.

Full Legal Name(Required)

Date of Birth(Required)

Gender(Required)

Male	Female

Marital Status(Required)

Single	Married	Divorced	Widowed	Common-Law	Separated	Other

Spouse’s Name and Last Name, if legally married. If no, type N/A(Required)

Cell Phone Number(Required)

Address(Required)

Email Address. If you don't have an email address, type: N/A(Required)

Birth Country(Required)

Birth City(Required)

Do you need an Interpreter to speak with the Legal Representative?(Required)

Yes, Spanish interpreter	Yes, Russian interpreter	No

Have you been a previous client in our Immigration Program?(Required)

Yes	No

How many times have you come to U.S.?:(Required)

Just once	2 times	3 or more times	I've never been to U.S.

When was your first entry into the U.S.? If you don't remember the exact date, give us the best estimate. If you have never come, type N/A(Required)

When was your last entry into the U.S.? If you don't remember the exact date, give us the best estimate. If you have never come, type N/A(Required)

How did you enter the last time into the U.S.?(Required)

Airport	Road, port of entry	Boat	Other	N/A, I am not in U.S.

Did you interact with immigration when you entered the last time?(Required)

No, I entered undetected	No, they let me in without talking or showing papers	Yes

Did you present documents to immigration when you entered the last time? Select all that apply(Required)

Valid Passport

Valid Visa

Valid Proof o f U.S. Residency

Other valid identification

Any other documents

No (or Not Applicable)

Highest level of education:(Required)

No Formal Schooling	Elementary School	Middle School	High School	Associated Degree	College / Universtity	Master / Doctoral Degree	Other

Do you currently work?(Required)

Yes	No	Other

How many people live in your household?(Required)

Just me	Two	Three	Four	Five or more

What is the household income? and how many people are supported with this income?(Required)

Who did you entered with the last time you came to the U.S.?(Required)

Have you ever lived in other country beside yours or the U.S.?(Required)

Yes	No

Have you ever been arrested or charged with a criminal offense? If your answer is Yes, please explain(Required)

What type of immigration assistance are you seeking from our organization? Select one of the options. if you don't see the best option for you, that means that we don't offer that service.(Required)

Ajustment of Status: Legal Residence	Naturalization	Asylum Application - No Representation in court	SIJ Visa	Family Based Petition	Consular Process	Fiancee Visa	T Visa	U Visa	VAWA	Removal of Conditions	General Consultation

Have you ever been required to appear before an Immigration Judge in court (Master or Individual hearing)?(Required)

Yes	No

Have you or has anyone in your family ever applied for a U.S. immigration benefit? Please explain. If the answer is NO, type N/A(Required)

How many children do you have?(Required)

No kids	1	2	3	4 or more

Based on what type of approval are you seeking the Adjusment of Status (Legal Residence)?(Required)

Have you left the country within the last 3 years (U-Visa holders)? For how long? If doesn't apply, type N/A(Required)

Do you have a current parole or came using CBP1 app?:(Required)

Yes	No

Do you have citizenship elsewhere?(Required)

Have you been scheduled to go to Immigration Court? What is the date of your next hearing? If you have not been scheduled yet, type N/A(Required)

Are you afraid to go back to your country? Please explain the reasons. If no, type N/A(Required)

Have you applied for asylum before, here or in other country? Explain. If no, type N/A(Required)

Have you been the victim of a crime in the US, or are you the spouse, parent or child of a crime victim? Explain.(Required)

Have you or someone else in your family ever served in the U.S. military?(Required)

Yes	No

How many years have you been a Legal permanent Resident or Green Card holder?(Required)

Why do you think the child has the opportunity to get a SIJ visa?(Required)

Who is responsible for the child? Where are the parents?(Required)

Tell us what happened to the child. Do you have evidences?(Required)

Did you report the crime to the police (a judge, prosecutor, someone from the government)?(Required)

Yes	No

Do you have the police report? It is a report in a sheet of paper.(Required)

Yes	No

Is there any minor involve in the crime?(Required)

Yes	No

Do you have evidences of the crime?(Required)

Yes	No

Has the crime affected you physically or emotionally? Please explain.(Required)

Has there been an investigation into the case? If so, have you been involved in assisting with the investigation?(Required)

Yes, and I have assisted in the investigation	Yes, but I have not assisted in the investigation	No, there has been no investigation	The case has already been closed

Have you been a victim of physical, mental or emotional abuse by a family member who is an American Citizen or Legal Permanent Resident? If so, by whom?(Required)

Spouse	Son > 21	Daughter > 21	Mom	Dad	I have not experienced abuse

Are you legally married to a:(Required)

American Citizen	Legal Permanent Resident	I'm not legally married

Do you live in common-law with:(Required)

American Citizen	Legal Permanent Resident	N/A

Can you describe what happened with your family member?. Do you have evidences?(Required)

Has anyone forced you to work against your will?(Required)

Yes	No

Have you worked in U.S. and not been paid? Or have you been paid less than agreed?(Required)

Yes	No

Has anyone held on your documents and ID in exchange for a job or a place to live?(Required)

Yes	No

Have you reported your situation to the authorities?(Required)

Yes	No

Where's your Fiancee?(Required)

In the U.S.	In his/her country of origin	In other country

How long have you been dating?(Required)

Has he/she ever been on a visa?(Required)

Yes	No

Have you seen each other in the last 2 years? Explain.(Required)

Does your Fiancee speak English?(Required)

Yes	No

The petitioner is an American Citizen or a Legal Permanent Resident?(Required)

Yes	No

The Beneficiary has Birth Certificates or a Marriage Certificate that prooves the relationship with the Petitioner?(Required)

Yes	No

Is the Beneficiary in the U.S.?(Required)

Yes	No

Have you received the approval of the I-130?(Required)

Yes	No

Have you received the e-mail from the NVC (for beneficiary that is out of the U.S.)?(Required)

Yes	No	N/A

How did you acquire conditional residency?(Required)

Through marriage	Through a parent

If you acquired the conditional residency through a parent, were you subject to extreme cruelty by the parent?(Required)

Yes	No	N/A

If you acquired the conditional residency through marriage, do you remain married?(Required)

Yes	No	N/A

If you acquired the conditional residency through marriage, are you divorced or are you considering a divorce?(Required)

Yes	No	N/A

If you acquired the conditional residency through marriage, are you living together?(Required)

Yes	No	N/A

Have you been subjected to cruelty by your spouse?(Required)

Yes	No	N/A

Would termination of your Legal Permanent Resident status and removal from the U.S. result in extreme hardship for you, How?(Required)

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Other services information:

Survey – Immigration Legal Services Client Survey (English)

Immigration Legal Services Client Survey

Immigration Intake Form - English Version

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