Immigration Law Office

Kevin Lawrence Dixler

Client Information

Please fill out this form the best you can and submit. Please be aware that it is best for experienced immigration attorneys to charge a consultation fee. The consultation which may last up to an hour cost only $225. You may pay the fee on at the LawPay Link, above. You will see the option(s) to pay once you complete this intake form. You may also wait until our meeting to make payment. You can always call me after completing the form. This fee is subtracted from any future agreement, where more assistance is needed. We need to know the information, below, in order to provide effective advice. As always, all the information supplied to attorneys are kept STRICTLY CONFIDENTIAL. We understand that some questions may not apply to you.

Name(Required)

First Middle Last

Alien Registration Number

Other names, aliases, maiden name, if married:

Present Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Is Your Permanent Mailing Address Different Than What's Listed Above?(Required)

Yes

Permanent Mailing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

Place Of Birth(Required)

Citizenship(Required)

Date of Birth

MM slash DD slash YYYY

Date of Birth (use this field only if you are on a screenreader or rely on your keyboard)

Marital Status(Required)

Married

Not Married

Widowed

Separated

Were your parents or grandparents born in the U.S. or did they ever live in the U.S.?(Required)

Yes

Can you return to country of birth or nationality without fear of persecution or imprisonment?(Required)

Yes

Have you, or your spouse, ever been arrested or convicted of any crime (in the U.S. or abroad, including traffic charges)? If yes, please explain(Required)

Yes

Please Describe Your Arrest Or Conviction

Can you make a substantial investment in the U.S.? (between $125,000 to $1M U.S.C.)(Required)

Yes

Not Sure

Not applicable

Have you ever been in an exclusion/deportation/removal proceeding? (If yes, please describe below)(Required)

Yes

Please Describe Your Exclustion/Deportation/Removal Proceeding

Have you ever represented yourself as a U.S. Citizen, registered to vote, or served on a jury? (Answer if NOT a US Citizen)

Yes

EDUCATION

Do You Have Any Post-HighSchool Education (University, Trade Schools etc) ?(Required)

Yes

Please Describe Your Education Including Your Field Of Study, Any Degrees Attained, Years Attended, Country Etc.

EMPLOYMENT

Are You Currently Employed?(Required)

Yes

Present Occupation

Current Employer

Salary

INFORMATION ABOUT YOUR FAMILY

Spouses Name

First Last

Spouse's Date Of Birth

MM slash DD slash YYYY

Spouse's Place Of Birth (if known)

Do You Have Children(Required)

Yes

Please List Your Children's Names, Dates of Birth & Countries of Birth Below

ENTRY INFORMATION

PASSPORT

NO:

Country

Valid Until

MM slash DD slash YYYY

DATE, PLACE AND MEANS OF LAST ARRIVAL IN THE US

AMERICAN VISA

Issued On

MM slash DD slash YYYY

Valid To

MM slash DD slash YYYY

Type of Visa

Type Of Immigration Matter You Need Assistance With(Required)

Were you an exchange (J-1) visitor?

Yes

When?

Have you ever filed documents or received any notices from the Immigration and Naturalization Service, or the American Consulate?(Required)

Yes

EMERGENCY INFORMATION

In case of an emergency (e.g., arrest by the Immigration Service), please list close relatives and friends whom we might contact to help assist you:

Emergency Contact Person Name 1(Required)

First Last

Emergency Contact Person 1 - Phone Number

Relationship of First Emergency Contact Person To Yourself (mother, brother, friend etc)

Emergency Contact Person Name 2

First Last

Emergency Contact Person 2 - Phone Number

Relationship of Second Emergency Contact Person To Yourself (mother, brother, friend etc)

Emergency Contact Person Name 3

First Last

Emergency Contact Person 3 - Phone

Relationship of Third Emergency Contact Person To Yourself (mother, brother, friend etc)

HOW DID YOU HEAR ABOUT US?

by:

Referred by a friend

Bar Association

Internet

Referred by another attorney

Newspaper

Organization

Yellow Pages

Avvo

Martindale Hubbell

Justia.com

Other

Where on the internet?

Avvo.com

Martindale Hubbell

Super Lawyers

Justia

Search Engine

Friend's Name

Attorney's Name

Is Your Case Only About You Or Is There Family Involved?(Required)

Only About Me

Others Are Involved

Have You Worked With Any Other Attorneys Before Reaching Out To Me?

Yes

Would You Prefer Me To Call You In The Upcoming Week?

Yes

Preferred Time to Call

Provide At Least 3 Ideal Times To Call (also, if you prefer me to use a different phone number than what is listed above, please provide that as well)

Do You Have Files Pertaining to USCIS, EOIR or Court Decisions, Notices or Requests That Concern Your Case?(Required)

Yes

Please Attach Any USCIS, EOIR or Court Decisions, Notices, or Requests that concern your case. If you have not documents, this is not required. Below are 3 options to upload files if necessary.

File

Max. file size: 300 MB.

File

Max. file size: 300 MB.

File

Max. file size: 300 MB.

File

Max. file size: 300 MB.

I understand that by providing answers, attaching documents, and checking the box below, no attorney client relationship exists; I must first attend a scheduled appointment/teleconference. The Law Office of Kevin L. Dixler may retain this information as a matter of discretion for the benefit of a potential client without further review.(Required)

I Understand

Use the space if any of the files you have attached need explanation

Opt me in for text messages!

Yes

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