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ONLINE Adult IMMIGRA...
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ONLINE Adult IMMIGRATION INTAKE FORM
ONLINE Adult IMMIGRATION INTAKE FORM
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Consultation and Confidentiality Policy
Instructions: Please answer all questions on the intake form as completely as possible. We must have all of this information to fully and accurately advise you regarding the immigration consequences faced by your client. If your client has a work permit, a green card, a visa, or any other documentation from immigration, please provide a copy. If you cannot get a copy, please ask for the “category code” that appears on the front of any work permit or green card, and/or the “A-number,” which is an 8- or 9-digit number also on those cards and on any other immigration documents. Information about the various immigration statuses and questions to ask your client can be found on our website, here. Please list all prior criminal history, whether misdemeanor or felony, dismissed, or expunged, etc. If your client has any criminal history in another state, you must provide the details of those convictions so that we can accurately advise you. Consider obtaining an FBI background check.
General Information
Attorney Name
*
First
Last
Attorney Email
*
Today's Date
*
Month
Day
Year
Public defender/assigned counsel?
Yes
No
Are you a WDA member?
*
Yes
No
If your agency is an organizational member, you are a member. Membership is not required for assistance.
Need Response By Date
Month
Day
Year
Urgent
Yes
No
If you need a response within 48 hours.
Case Type
Criminal Case
Immigration Case
Post Conviction Relief Case
Immigration case: Describe the immigration issue
*
Client Information
Client Name
*
First
Last
Client Date of Birth
*
Month
Day
Year
Client Country of Birth
*
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Swaziland)
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Réunion
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Client is...
*
In Custody
Out of Custody
Immigration Information
Date of First Entry into the U.S.
*
Month
Day
Year
Additional Dates of Entry/Exit from the U.S.
If your client entered the U.S. more than once, please provide all dates (mo/yr) of entry/exit.
Add
Remove
Immigration Status
*
LPR - Lawful Permanent Resident (greencard)
Refugee (approved before arrival in U.S.)
Asylum Applicant (applied in U.S., still pending)
Asylum Granted (by Immigration Judge or USCIS)
DACA
Undocumented
Previously Deported
Caught and Fingerprinted at Border by ICE/CBP
Unknown
Other * indicate details below
Since When?
Entered
Without Inspection
Expired Visa
Previously Ordered Deported
By ICE/CBP
Immigration Judge
Actually Left
Yes
No
When Left
Month
Day
Year
When Returned
Month
Day
Year
Comments on Immigration Status
Family Ties
Spouse/Partner is...
*
Please choose
USC
LPR
Undocumented
Refugee
Asylee
Unknown
Not in U.S. and not a U.S. Citizen
None
Since when?
Mother is...
*
Please choose
USC
LPR
Undocumented
Refugee
Asylee
Not in U.S. and not a U.S. Citizen
Unknown
None
Since when?
Father is...
*
Please choose
USC
LPR
Undocumented
Refugee
Asylee
Not in U.S. and not a U.S. Citizen
Unknown
None
Since when?
USC Grandparents
*
Yes
No
Unknown
Does your client have children?
*
Yes
No
Children
Age
Immigration Status
Add
Remove
Possible Immigration Statuses Include: USC, LPR, DACA, Undocumented, Unknown
Current Charges
County where client is charged
*
Other
Adams
Asotin
Benton
Chelan
Clallam
Clark
Columbia
Cowlitz
Douglas
Ferry
Franklin
Garfield
Grant
Grays Harbor
Island
Jefferson
King
Kitsap
Kittitas
Klickitat
Lewis
Mason
Okanogan
Pacific
Pierce
San Juan
Skagit
Skamania
Snohomish
Spokane
Stevens
Thurston
Wahkiakum
Walla Walla
Whatcom
Whitman
Yakima
Current Charges
Charge
Statute
Date Offense Allegedly Committed
Court Type & Location (Muni, District, Superior, Other)
Drug Related (Yes or No)
DV Tag
Add
Remove
Plea Offer for Current Charge
Criminal History
Previous Criminal Convictions (Anywhere)?
*
Yes
No
Where?
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Criminal History WA
Charge
Statute
Date of Conviction
Sentence
Court Type & Location (Muni, District, Superior, Other)
Drug Related (Yes or No)
DV Tag
Deferred Adjudication (Yes or No)
Add
Remove
List all offenses, including deferred adjudications and juvenile history.
Criminal History (Anywhere)
Charge
Statute
Date of Conviction
Sentence
Court Type & Location (Muni, District, Superior, Other)
Drug Related (Yes or No)
DV Tag
Deferred Adjudication (Yes or No)
State
Add
Remove
List all offenses, including deferred adjudications and juvenile history.
Upload any relevant files (optional)
Drop files here or
Select files
Max. file size: 256 MB.
CAPTCHA
Email
This field is for validation purposes and should be left unchanged.
ABOUT
Mission, Vision & Core Values
Membership Benefits
Join WDA!
WDA Staff
WDA Board
News & Updates
CASE SUPPORT
Immigration Project
Incarcerated Parents Project
Felony Case Consultation
Misdemeanor Case Consultation
Resentencing and Post Conviction Case Support
TRAINING
Upcoming Training and Events
Recent Training
Past Training
RESOURCES
Brief Bank
Practice Advisories
Case Law Updates
Listservs
Expert Bank
Investigators Network
Defender Well-Being
Finding Legal Help
ENGAGE
Join
Legislative and Policy Advocacy
Amicus Advocacy
Position Openings
Defender Innovation Projects
Defenders Rising
Internships and Externships
Gideon and President’s Award Winners
WDA Committees and Workgroups
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