Online Juvenile Immigration Intake Form

Attorney Name*

First Last

Attorney Email*

County where client is charged*

Public defender/assigned counsel?*

Yes
No

(Are you representing an indigent client in this case?)

Are you a WDA member?*

Yes
No

(if your agency is an organizational member, you are a member. Membership is not required for assistance.)

Today's Date*

Need Response By Date and Time*

If urgent and response needed within 48 hours please mark URGENT here

Defendant Identifier

(Not Required)

Defendant's DOB*

Defendant's Place of Birth*

Date of Entry into the U.S.*

Defendant is...*

in custody
out of custody

Immigration Status*

LPR - Lawful Permanent Resident (greencard) *indicate below since when, if different than date of entry
Refugee or granted asylum status *indicate below since when, if different than date of entry
Undocumented (entered illegally)
DACA
Previously Deported
Unknown *NOTE: WDA’s Immigration Project staff cannot provide you with accurate advice about the immigration consequences facing your client without knowing client’s specific immigration status. Please communicate with your client to determine status before submitting this form. If your client is unclear about her/his status, please provide details of what is known in comments below. Also, please see our Determining Immigration Status Resource for helpful questions to ask your client.
Other * indicate details below

If LPR or refugee, please write in since when in the comments box below. If undocumented, please write in when defendant entered the country. If previously deported, please write in whether defendant was deported by ICE or an immigration judge.

Comments on Immigration Status*

Indicate when client obtained lawful status or came to the US or was previously deported.

ICE Detainer*

Yes
No

Complete Delinquency History*

Include offense, date of adjudication and sentence (including suspended time) for each adjudication. Include arrests, deferred adjudications, deferred sentences, or other resolutions. Be sure to indicate if DV or drug-related, or if there were any gang allegations or findings.

Decline Assessment

Discretionary Decline Possible
Mandatory Decline Hearing
Automatic Decline

Current Charges*

(indicate whether your client is charged as an adult or juvenile, and if charge is DV or drug-related, or if there were any gang allegations)

Plea Offers for Current Charge*

Defendant's Goals Re: Immigration Consequences*

Preserve eligibility to obtain future immigration benefits (e.g. LPR status or citizenship)
Preserve ability to ask immigration judge to get/keep lawful status and stay in U.S.
Get out of detention ASAP

Spouse/Partner is...*

Mother is...*

If USC, since when?

Father is...*

If USC, since when?

If your client has a child, what is the child's status?*

Siblings: list age and immigration status for each*

If none, please write "no children" in the box below.

Include offense, date of adjudication and sentence (including suspended time) for each adjudication. Include arrests, deferred adjudications, deferred sentences, or other resolutions.*

Dependent youth/potential dependency
Has been the victim of a crime of DV while in U.S.
Fears returning to home country
Has been in forced labor or prostitution in U.S.

Check all that apply. If dependent, please note history of abuse, abandonment or neglect, and whether the youth lives in foster care or in guardianship. If victim of DV, please note whether crime was reported to law enforcement or CPS.

Comments on Indicators of Possible Immigration Relief

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Online Juvenile Immi...

Juvenile Immigration Intake Form

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