Nava Law Firm - Intake Form Name * First Name Last Name Email * What problems do you hope that we can help you solve? When did you first enter the US? MM DD YYYY Did you enter with visa/permit? How? When was the last time you entered the US? MM DD YYYY Did you enter with visa/permit? How? Have you ever been ordered removed/deported? Yes No Have you ever applied for immigration benefit like DACA, TPS, Cancellation, U-Visa, T-Visa, SIJS (juvenile)? Have you ever applied for immigration benefit like DACA, TPS, Cancellation, U-Visa, T-Visa, SIJS (juvenile)? What was the result? Have any petitions been filed on your behalf by family or employer before? Yes No Were you parents or grandparents U.S. Citizens? * Yes No Are you married? * Yes No Status of Spouse Marriage Date MM DD YYYY Do you have children? Yes No Age, place of birth, immigration status of children? Have you ever had trouble with police or been arrested in the US? Yes No Do you have any reason to fear returning to your country? If so, why? and Who would harm you if anyone? Have you ever been the victim of domestic violence by a spouse, parent, or child? Yes No Have you ever been threatened or harmed by a spouse, parent, child? Yes No Have you ever been the victim of a VIOLENT crime? Yes No If yes, was a police report made or help with the investigation or prosecution? Yes No Have you ever been forced to work in the US? Yes No What is your highest level of education? What degrees do you hold if any? Submission Received Thank you!