Immigration Document Preparation Questionnaire

General Information for Individual Client
1. First Name:
2. Last Name:
3. Middle Name:
4. Maiden Name:
5. Title (Mr, Ms, Mrs):
6. Marital Status:
7. Gender:
8. Date of Birth (mm/dd/yyyy):
9. City of Birth:
10. State of Birth:
11. Country of Birth:
12. Day Phone:
13. Cell Phone:
14. Evening Phone:
15. Fax:
16. Email:
17. SSN (Social Security Number):
18. Nationality:
19. Alien Number:
20. Passport #:
21. Passport Issuing Country:
22. Passport Issue Date:
23. Passport Valid until:
24. Arrival Date:
25. Arrival City:
26. Arrival State:
27. Major Field of Study (e.g. Computer Science, Medicine, Electrical Engineering, Economics):
28. Degree (e.g. High School Diploma, Bachelors, Masters, PhD):
29. Father Full Name:
30. Father Date of Birth:
31. Father Place of Birth:
32. Father Nationality, and (A # if any):
33. Mother Full Name:
34. Mother Date of Birth:
35. Mother Place of Birth:
36. Mother Nationality, and (A # if any):
Other Names for Individual Client
First Name: Middle Name: Last Name:
Addresses for Individual Client
Mailing Address
1. Care of:
2. Street:
3. Unit:
4. City:
5. State:
6. Zip Code:
7. Country:

US Residence Address
1. Care of:
2. Street:
3. Unit:
4. City:
5. State:
6. Zip Code:

Abroad Residence Address
1. Care of:
2. Street:
3. Unit:
4. City:
5. State:
6. Zip Code:
7. Country:

Consulate Address
1. Care of:
2. Street:
3. City:
4. State:
5. Zip Code:
6. Country:
General Information for Individual Client’s Children #1
1. Child Full Name:
2. Child Date of Birth:
3. Child Place of Birth:
4. Child Nationality and (A # if any):
5. Children's Full Address:
General Information for Individual Client’s Children #2
1. Child Full Name:
2. Child Date of Birth:
3. Child Place of Birth:
4. Child Nationality and (A # if any):
5. Children's Full Address:
General Information for Individual Client’s Children #3
1. Child Full Name:
2. Child Date of Birth:
3. Child Place of Birth:
4. Child Nationality and (A # if any):
5. Children's Full Address:
General Information for Individual Client’s Children #4
1. Child Full Name:
2. Child Date of Birth:
3. Child Place of Birth:
4. Child Nationality and (A # if any):
5. Children's Full Address:
Relative's Information for Individual Client
Relationship to you (this person is your Spouse, Son, Brother, etc.):
1. First Name:
2. Last Name:
3. Middle Name:
4. Maiden Name:
5. Title (Mr, Ms, Mrs):
6. Marital Status:
7. Gender:
8. Date of Birth (mm/dd/yyyy):
9. City of Birth:
10. State of Birth:
11. Country of Birth:
12. Day Phone:
13. Cell Phone:
14. Evening Phone:
15. Fax:
16. Email:
17. SSN (Social Security Number):
18. Nationality:
19. Alien Number:
20. Passport #:
21. Passport Issuing Country:
22. Passport Issue Date:
23. Passport Valid until:
24. Arrival Date:
25. Arrival City:
26. Arrival State:
27. Major Field of Study (e.g. Computer Science, Medicine, Electrical Engineering, Economics):
28. Degree (e.g. High School Diploma, Bachelors, Masters, PhD):
29. Father Full Name:
30. Father Date of Birth:
31. Father Place of Birth:
32. Father Nationality, and (A # if any):
33. Mother Full Name:
34. Mother Date of Birth:
35. Mother Place of Birth:
36. Mother Nationality, and (A # if any):
Relative's Information for Individual Client’s Children #1
1. Child Full Name:
2. Child Date of Birth:
3. Child Place of Birth:
4. Child Nationality and (A # if any):
5. Children's Full Address:
Relative's Information for Individual Client’s Children #2
1. Child Full Name:
2. Child Date of Birth:
3. Child Place of Birth:
4. Child Nationality and (A # if any):
5. Children's Full Address:
Relative's Information for Individual Client’s Children #3
1. Child Full Name:
2. Child Date of Birth:
3. Child Place of Birth:
4. Child Nationality and (A # if any):
5. Children's Full Address:
Relative's Information for Individual Client’s Children #4
1. Child Full Name:
2. Child Date of Birth:
3. Child Place of Birth:
4. Child Nationality and (A # if any):
5. Children's Full Address:
Biographic Information for Individual Client
1. Ethnicity:
2. Race:



3. Height in Feet:
4. Height in Inches:
5. Weight:
6. Eye Color:
7. Hair Color:
Biographic Information for Relative
1. Ethnicity:
2. Race:



3. Height in Feet:
4. Height in Inches:
5. Weight:
6. Eye Color:
7. Hair Color:
History of Address #1
NOTE: Please do NOT include your Current Address.
1. Street:
2. Unit:
3. City:
4. State:
5. Zip Code:
6. Country:
7. From (mm/dd/yyyy):
8. To (mm/dd/yyyy):
History of International Travel #1
1. Countries Visited:
2. Purpose of your trip:
3. Date you left U.S.:
4. Date you returned to U.S.:
5. # of Days Outside U.S.:
6. Trip Lasted 6 Months or More?
7. Departure Port/city:
8. Arrival Port/city:
9. Entry Status:
10. Check if Admitted:
History of Marriages #1
NOTE: Please include your Current History of Marriage.
Marriage Information
1. Date of Marriage (mm/dd/yyyy):
2. City:
3. State:
4. Country:
5. Date of your divorce (if applicable) (mm/dd/yyyy):
6. City:
7. State:
8. Country:
9. Check if this is your Current Marriage:

Spouse Information
1. First Name:
2. Last Name:
3. Middle Name:
4. Maiden Name:
5. Date of Birth (mm/dd/yyyy):
6. Gender:
7. Nationality and ( A # if any):
8. Employer Name and Address (if any):
History of Employment #1
1. Employer Name:
2. Business Type:
3. Job Title:
4. Job Description:
5. Supervisor Name:
6. Hours Per Week:
7. Street:
8. Unit:
9. City:
10. State:
11. Zip Code:
12. Country:
13. Email:
14. Phone:
15. Fax:
16. From (mm/dd/yyyy):
17. To (mm/dd/yyyy):
18. Check if this is your current Employment:
Citations, Arrests, Convictions (if any)
1. Why were you arrested, cited, detained, or charged?
2. Date arrested, cited, detained, or charged:
3. Where were you arrested, cited, detained or charged? (City, State, Country)
4. Outcome or disposition of the arrest, citation, detention or charge. (No charges filed, charges dismissed, jail, probation, etc.)
Naturalization Specific Questions
If you answer "Yes" to any of these questions by setting the checkbox to the left of the questions, include an explanation. Your explanation should (1) explain why your answer was "Yes", and (2) provide any additional information that helps to explain your answer.
1. Have you ever claimed to be a U.S. citizen (in writing or any other way)?
2. Have you ever registered to vote in any Federal, state, or local election in the United States?
3. Have you ever voted in any Federal, State, or local election in the United States?
4. Since becoming a lawful permanent resident, have you ever failed to file a required Federal, State, or local tax return?
5. Do you owe any Federal, State, or local taxes that are overdue?
6. Do you have any title of nobility in any foreign country?
7. Have you ever been declared legally incompetent or been confined to a mental institution within the last five years?
8. Since becoming a Lawful Permanent Resident of the United States have you ever called yourself a "nonresident" on a Federal, State, or local tax return?
9. Since becoming a Lawful Permanent Resident of the United States have you ever failed to file a Federal, State, or local tax return because you considered yourself to be a "nonresident"?
10. Have you ever been a habitual drunkard?
11. Have you ever been a prostitute, or procured anyone for prostitution?
12. Have you ever sold or smuggled controlled substances, illegal drugs or narcotics?
13. Have you ever been married to more than one person at the same time?
14. Have you ever helped anyone enter or try to enter the United States illegally?
15. Have you ever gambled illegally or received income from illegal gambling?
16. Have you ever failed to support your dependents or to pay alimony?
17. Have you ever given false or misleading information to any U.S. Government official while applying for any immigration benefit or to prevent deportation, exclusion, or removal?
18. Have you ever lied to any U.S. Government official to gain entry or admission into the United States?
19. Have you ever been arrested for, charged with, or convicted of a felony or misdemeanor in the United States? Do not include minor traffic violations that only resulted in a fine, unless it was alcohol- or drug-related?
20. Have you ever been arrested for, charged with, or convicted of a crime in any country other than the United States?
21. Have you ever engaged in or do you continue to engage in or plan to engage in terrorist activities?
22. Are you now or have you ever been a member of a gang?
23. Have you ever engaged in, ordered, incited, assisted or otherwise participated in Acts involving torture, genocide, or human trafficking?
24. Have you ever engaged in, ordered, incited, assisted or otherwise participated in Killing any person?
25. Have you ever engaged in, ordered, incited, assisted or otherwise participated in Severely injuring any person?
26. Have you ever engaged in, ordered, incited, assisted or otherwise participated in Any kind of sexual contact or relations with any person who was being forced or threatened?
27. Have you ever been a member of or associated with any organization, association, fund, foundation, party, club, society, or similar group in the United States or in any other place?
28. Have you ever been a member of or in any way associated (either directly or indirectly) with the Communist Party?
29. Have you ever been a member of or in any way associated (either directly or indirectly) with any other totalitarian party?
30. Have you ever been a member of or in any way associated (either directly or indirectly) with a terrorist organization?
31. Have you ever advocated (either directly or indirectly) the overthrow of any government by force or violence?
32. Have you ever persecuted (either directly or indirectly) any person because of race, religion, national origin, membership in a particular social group, or political opinion?
33. Between March 23, 1933, and May 8, 1945, did you work for or associate in any way (either directly or indirectly) with the Nazi government of Germany?
34. Between March 23, 1933, and May 8, 1945, did you work for or associate in any way (either directly or indirectly) with any government in any area (1) occupied by, (2) allied with, or (3) established with the help of the Nazi government of Germany?
35. Between March 23, 1933, and May 8, 1945, did you work for or associate in any way (either directly or indirectly) with any German, Nazi, or S.S. military unit, paramilitary unit, selfdefense unit, vigilante unit, citizen unit, police unit, government agency or office, extermination camp, concentration camp, prisoner of war camp, prison, labor camp, or transit camp?
36. Have you ever committed a crime or offense for which you were not arrested?
37. Have you ever been arrested, cited or detained by any law enforcement officer (including USCIS or former INS and military officers) for any reason?
38. Have you ever been charged with committing any crime or offense?
39. Have you ever been convicted of a crime or offense?
40. Have you ever been placed in an alternative sentencing or a rehabilitative program (for example: diversion, deferred prosecution, withheld adjudication, deferred adjudication)?
41. Have you ever received a suspended sentence, been placed on probation, or been paroled?
42. Have you ever been in jail or prison?
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