Name
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Spouse’s Immigration Status US CitizenLegal Resident (has green card)Pending Application for Residency Pending Asylum ApplicationDACANo StatusIn Removal ProceedingsUnsureNo Spouse
Number of Children
Check All That Apply One of My Children is Over the Age of 21 One of My Children is a US Citizen One of My Children is a Permanent Resident One of My Children Has DACA None of My Children Have Status in the US
Have You Ever Applied For An Immigration Benefit Before? YesNoUnsure
Describe Any Medical, Phycological, Emotional, Behavioral, or Developmental Conditions That Your Spouse or Any of Your Children Have
Check Any That Apply crim record removal order multiple entries
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Entry to the US
Manner of Entry to the US Entered on VisaEntered with ParoleCBP One AppCrossed Land BorderUnsureOther
Country of Birth
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