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WDA's Immigration Project - Intake Questionnaire

This form is confidential and protected by attorney-client privilege. For technical assistance, pleave provide the following information to Jonathan Moore by email or phone at: email: jonathan@defensenet.org phone: (206) 726-3332

Your E-Mail Address (Required)

Subject (Required)

Comments (Required)

Your Name: (Required)

Date of Inquiry: (Required)

Relationship to Noncitizen Defendant: (Required)

Agency of firm: (Required)

County: (Required)

Telephone: (Required)

Email Address: (Required)

Client's Country of Origin: (Required)

Client's Current Immigration Status: (Required)

If Client has lawful status, how and when did he/she get it? (Required)

(E.G. Client entered the U.S. in 1981 as a refugee from Cambodia; client got greencard through her U.S. citizen spouse in 1993; client entered on tourist visa.)

Client's current charge and any offers: (Required)

Client's criminal history. Include conviction, sentence (imposed and suspended) and juvenile history. (Required)

If possible list client's immediate relatives (spouse, parent(s) and/or child(ren)) who are U.S. citizens or lawful permanent residents (greencard holders). (Required)

Thank you for submitting this form online. The information provided will be submitted to WDA's Immigration Project Technical Assistance Staff and they will contact you as soon as possible.

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