VALENCIA (SANTA CLARITA), CA 91355 -USA
(661) 294-0911
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Name
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1st Name and MI
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Full Address
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Date of Birth
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Gender
Male
Female
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Place of Birth
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Other Names Used
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Date You First Came to US
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Date You Last Came to US
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Place You Last Came to the US
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Enter the City, the Town and/or State or Airport or other port of entry or place you landed at when you last came to the US
Did you Come to US with a Visa?
Yes
No
Maybe
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If you check "Maybe," then we will want you to check and be certain before we continue with your application
Your Highest Level of Education
Elementary
Junior High
High School
GED
Community College
University
Still in School
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Are you in the Military?
Yes
No
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Ever Leave the US? When and How Long You Left For?
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Give "From AND To" Dates
Ever Been Arrested, Convicted and/or Jailed?
Yes
No
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Answer Yes if you Have a Criminal Record (Misdemeanors, Felonies, Etc.) of Any Kind. Do not Include Traffic Tickets
If Your Answer is YES, then Tell us How Many Times and for each Time, Include 1) When and Why You were Arrested; 2) What You Were Charged With; 3) Where You Were Arrested; 4) How the Case(s) Ended; 5) If You are on Probation
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Please Tell us About Any Criminal Record you Might Have and Give as Much Detail as you can so that We Would Have a Better Idea How to Help Move Your Case Forward. Tell us Everything You Know about any Criminal Record.
Are You Now or Ever Been Before an Immigration Judge?
No
I Currently am Before an IJ
My Case was Administratively Closed
My Case was Terminated
I was Ordered Deported
Yes, but I Can't Say Which One Applies to Me
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Please Choose Only One Option
What Type of Application is This for?
Family Visa (Adjustment, K1/K3,245i AOS)
Business/Work Visa (E1, E2, H1B, EB1,EB2)
Deferred Action
Waiver
Violence Against Women Act (VAWA)
Political Asylum
Citizenship/Naturalization
Temporary Protected Status (TPS)
Deportation/Removal
Cancellation of Removal
U-VISA
Other
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Choose Only One Option and if you do not see What you are Looking for, then just Choose "Other"
Who Will File a Petition for You?
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Enter the Name of the Person or Company that will File an Application for You if You Have One. Give the Citizenship or Status of that Person, Address, Telephone # and Any information about them as you can Think of at this Time.
How Would You Like to Complete this Application?
Online Only
Email and Regular Mail
Regular Mail Only
I Want an Office Appointment
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E-mail Where We Can Contact You
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Phone Number Where We Can Call You
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