CHD will never release or share any client information to third parties without client consent. We maintain strict client confidentiality practices. "*" indicates required fields Full legal name* Phone number*Email (if any) Mailing address Street Address City State / Province / Region ZIP / Postal Code Preferred language? What service do you need? ADJUSTMENT OF STATUS CONSULTATION CITIZENSHIP DACA (INITIAL) DACA (RENEWAL) FOIA GREEN CARD RENEWAL OR REPLACEMENT PETITION WORK AUTHORIZATION OTHER CONSULTATIONDate and place of first entry into the United States How did you enter the United States? With a visa or without inspection? Date and place of last entry into the United States State if you have more than one entry into the United States. If yes, list all entries Has anyone filed an immigration application or petition for you before April 30, 2001? Yes No Has anyone EVER filed a petition for you? Yes No Have you ever been arrested? Yes No Have you ever claimed to be a U.S Citizen? Yes No Country of birth Are you under the age of 18 with a green card and your parents became U.S. citizens? What is your current marital status? Single (never married) Engaged Married Separated Divorced Widowed Do you have any children born in the U.S.? if yes, what age? Have you ever been a victim of a crime? If yes, do you have a police report? Are you seeking information for initial DACA? Addition notesCITIZENSHIPDate of birth MM slash DD slash YYYY Country of birth Date of legal permanent residence MM slash DD slash YYYY Have you ever been arrested? If yes, what types of crime and when? Do you owe taxes to the IRS? If yes, do you have a payment plan? Have you been absent from the United States for more than 180 days in one year? Have you ever been deported? If yes, why, and when? Have you worked in the Marijuana industry? Additional notesDACA (RENEWAL)Are you an existing client with CHD? Yes No Date of the expiration date on your work authorization MM slash DD slash YYYY Date of birth MM slash DD slash YYYY City, State, and Country of birth A # Current marital status Single (never married) Engaged Married Separated Divorced Widowed Date of the last arrival into the United States. MM slash DD slash YYYY Have you left the United States with or without advanced parole? Have you ever been arrested? Yes No Additional notesGREEN CARD RENEWAL OR REPLACEMENTA # Date of the expiration date on Green Card MM slash DD slash YYYY Date of birth MM slash DD slash YYYY City, State, and Country of birth Location where you filed for permanent residency? Location where your residency was approved. Inside the United States or U.S. Consulate outside the United States? Have you been arrested since you received your green card or last renewal? Additional notesCommentsThis field is for validation purposes and should be left unchanged. Δ
