Online Immigration Intake Form

Attorney Name (Required)

Attorney E-Mail Address (Required)

Primary County of Practice (Required)

Select the county in which you handle the most cases.

Are you a WDA member? (Required)

(if your agency is an organizational member, you are a member)

Yes
No

Today's Date (Required)

Defendant Identifier

(Not Required)

Need Response By Date (Required)

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

Defendant's DOB (Required)

Defendant's Place of Birth (Required)

Date of Entry into U.S. (Required)

Defendant is... (Required)

in custody
out of custody

ICE Detainer (Required)

Yes
No

Complete Criminal History (Required)

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

Current Charges (Required)

Plea Offers (Required)

Defendent's Goals Re: Immigration Consequences (Required)

Other Goals Re: Immigration Consequences

Immigration Status (Required)

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.

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)

Previously Deported

Other * indicate details below

Comments on Immigration Status (Required)

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

Spouse/Partner is (Required)

Mother is

Father is

Children: list age and immigration status for each

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

Kids are

Sections

Personal tools