ROBERT F. BELLUSCIO, Attorney At Law

MAIL-IN QUESTIONNAIRE

NOTE: PLEASE FILL OUT A SEPARATE QUESTIONNAIRE FOR EACH FAMILY MEMBER INTERESTED IN A U.S. IMMIGRATION CLASSIFICATION. IF YOU ARE MARRIED, ONE SHOULD BE FILLED OUT FOR YOUR SPOUSE.

Please mail-in your completed questionnaire, along with your check or a money order for US$100.00. This fee will be credited to any case you do if you hire us within 30 days of your consultation. We suggest that you send your items by certified or express mail return receipt or by a courier service such as Federal Express so that you know when we receive them. You may also fax the questionnaire and documents to us, and send your payment via Credit Card, which is what you should do after calling us, if this is an emergency. After you know we have received your information, documents, and payment, please call our office for an appointment to discuss your matter by telephone.

DO NOT SEND ORIGINAL DOCUMENTS. SEND ONLY PHOTOCOPIES.

Please attach a complete copy of your passport and I-94, if you have these. Please be sure to copy all pages which have any stamps or notations on them, including inside front and back covers. Please also attach copies of any other documents which might be useful for us to see. If you have any applications or correspondence to or from the Immigration office, or a Consulate or Embassy, please also include copies of these. Please also attach a statement of anything else you would like us to know which is not covered in the following questions. If you have any specific idea as to how you believe we can help you, please also mention this. Please answer all of the following questions as best as possible. Thank you.

 

DATE:

          (LAST)         (FIRST)           (MIDDLE)      
NAME:                                                            

   
ADDRESS:                                                         

              
TELEPHONE:   (H)                      (W)                    

HOW DID YOU LEARN ABOUT OUR LAW OFFICE?

If you know any of our clients, please list their names.

WHAT LANGUAGES DO YOU SPEAK?

COUNTRY OF BIRTH:                       DATE OF BIRTH:          

HOW LAST ENTERED THE U.S.:              LAST ENTRY:              

WERE THERE ANY PREVIOUS ENTRIES?  YES___   NO___

MARITAL STATUS:                 PREVIOUSLY MARRIED: Yes___  No___

HAS PRESENT SPOUSE BEEN MARRIED PREVIOUSLY:  Yes___ No___

                        STATUS OF FAMILY

WHERE ARE THE FOLLOWING FAMILY MEMBERS and WHAT IS THEIR U.S.
IMMIGRATION STATUS?
Please specify- are they U.S. CITIZENS;
 LAWFUL U.S. PERMANENT RESIDENT ALIENS;
 NOT LAWFUL U.S. PERMANENT RESIDENT ALIENS AND NOT IN THE U.S.;
 DECEASED; IN THE U.S. AS NON-IMMIGRANTS; 
  or ILLEGALLY IN THE U.S. 
     _______________________________________________________
SPOUSE:                                                     
     _______________________________________________________
MOTHER:                                                     
     _______________________________________________________
FATHER:                                                     
     _______________________________________________________
SIBLINGS:                                                   
     _______________________________________________________
CHILDREN:                                                   
     _______________________________________________________

Were either of your parents (or your spouse's parents) United
States Citizens?  YES_____   NO_____

Were either your grandparents (or your spouse's grandparents)
United States Citizens?   YES___  NO___

List any other citizenships or nationalities which you possess.

Any criminal arrests or convictions in U.S. or outside the U.S.? 
YES____   NO____                                                 

Any previous immigration applications? YES ____  NO____   (specify)

Any previous problems with the Immigration office?  YES ____   NO____   

Any previous problems with a U.S. Consulate, Embassy,  or A.I.T.?
                                           YES____   NO____      

Any fear of returning to home due to political reasons? 
                                       YES___ NO___    

Please list your present and past OCCUPATIONS OR PROFESSIONS:
              Present                     Past
a)Yourself:                                                    

b)Your spouse:                                                   

  
Do You own a business in the U.S.?   Yes____   NO____

Do You own a business abroad?  YES____   NO____

Are You a Manager or Executive of a company abroad? 
                      YES____   NO____            

Can you invest a substantial amount of money in a business in the
United States?  YES___  NO___  
   If yes, specify how much you can invest - for example, 
   US$100,000, US$150,000 US$200,000, etc._______________________

What is the education of yourself and your spouse?  If you have a
college degree, please specify the major.

a) Yourself                       b)Spouse          

Are you presently attending school? YES___ NO___

Is your Spouse presently attending school?  YES___  NO___   

Do you have an employer or future employer who wishes to sponsor you? If so, please specify the type of business, your position, your salary, and your job duties. If you know how many employees the business has and the gross and net annual income, please also specify these below. Please also give us the name, title, address, and phone number of the person in that business we should contact if necessary.

IMPORTANT: If you have any fixed DEADLINE or appointment date, such as an Immigration Court date, OR your status is about to expire, please be sure this information arrives AT LEAST 45 days before your appointment or deadline. If you do NOT have that much time, we suggest that you call our office and make special arrangements, or come in person to our office. Writing or contacting our office will NOT excuse you from missing your deadline or appointment.

Further Note: Sending us this form and your payment is for the purposes of obtaining a consultation and evaluation and does not mean that you have hired the Law Offices of Robert F. Belluscio to represent you.

Robert F. Belluscio, Attorney At Law
142-03 37th Ave. · Flushing, N.Y. 11354
718 445-1500 ·
Outside of New York: 800-363-5677 ·
FAX: 718 358-9849

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Copyright © 1996-1998 Robert F. Belluscio, Attorney At Law. All rights reserved.