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Immigration Legal Intake Service

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If you are undocumented, have DACA or TPS, the first step to taking control of your future is finding out about your options. The Immigration Law Intake Service is a free, anonymous and personalized online service staffed by legal service professionals that helps you learn about your immigration options.

Immigration Legal Intake Service

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Disclaimer

Immigrants Rising, which was formerly known as Educators for Fair Consideration (E4FC), and is a fiscally sponsored project of Community Initiatives (CI), was granted Department of Justice (DOJ) recognition by the U.S. Department of Justice under the name Community Initiatives - Immigrants Rising (CI-Immigrants Rising). Although CI-Immigrants Rising (also doing business as "Immigrants Rising") has the authority to assist undocumented individuals before the Department of Homeland Security, we do not currently provide direct representation or legal advice.

Each intake is reviewed by a U.S. licensed immigration attorney or Department of Justice (DOJ) Accredited Representative. Your consultation with us is meant to collect basic information about your situation to allow us to provide relevant informational material about legal rights and processes that may be applicable to you. We cannot take you on as a client. We cannot advise you of any deadlines or tell you the best course of action to take or not take in any legal case.

This intake service is not designed for urgent or emergency inquiries. If you require immediate attention you can find a non-profit legal service provider using www.immigrationlawhelp.org.

Immigrants Rising will make every effort to keep your private information confidential. We will not disclose any information about you unless we are legally required to do so. Immigrants Rising is not a law firm and has no attorney-client relationship with you, so our communications with you are not protected by the attorney-client privilege.

We value the security of our users and we take precautionary steps to keep the information you provide to us safe. The platforms we use to collect and store information, such as Salesforce NPSP, Form Assembly, and Box, have native encryption capabilities both "at rest" and "in transit." These services are ISO 27001 certified, which is the global standard for information security management.

By selecting "Next Page," you agree that you have read and understood the disclaimer described above.

General Information

We use this information to contact you and help provide you with resources and

legal services we know about that are available to undocumented young

people in your area.

First Name

Please use an alias instead of your real name. Pick a fun nickname (i.e. Obi-Wan, SpongeBob.) However, please choose an alias that you will remember because we will use that name in all of our communication with you.

Last Name

Please use an alias instead of your real name. Pick a fun nickname (i.e. Kenobi, Squarepants.) However, please choose an alias that you will remember because we will use that name in all of our communication with you

Email

We will use this email to contact you if we need further information and/or send you the results of our analysis. Due to the sensitivity of this information, please provide a valid and permanent personal email address where we can send you PRIVATE messages.

Phone

Please provide a phone number so we can contact you if we need further information and/or to notify you we have completed our analysis. A PRIVATE cell phone number would be ideal so we can text messages meant only for you.

City of Residence

State of Residence

Zip Code

Country of Origin/ Country of Birth

Please provide the country where you were born (do not list the United States)

Date of Birth

MM/DD/YYYY

Ethnicity origin (or Race): Please specify your ethnicity. Select all that apply.

White Black or African AmericanNative American or American IndianAsian/Pacific IslanderHispanic or LatinoOther

Other

Your Experience with Legal Assistance

What is the most important reason you chose to use this Immigration Legal Intake Service?

Cost: It's freeAccessibility: It's onlineAnonymity: You don't know meConfidentiality: You won't tell anyone about my caseQuality: I heard the service is reliableFamiliarity: I know someone who's used this serviceOther

Other

How did you find out about this Immigration Legal Intake Service?

Immigrants Rising's Community Education TeamTeacher/CounselorFriendWeb SearchFacebookPostcardUnited We DreamPre-Health DREAMersInvest in the Dreamthedream.usOther

Other

Have you (or someone else in your family) ever received professional legal assistance?

YesNo

What kind of professional legal assistance did you receive?

Private immigration attorneyNon-profit law agencyImmigration consultant (Notario)Other

Other

How satisfied were you with the professional legal assistance you received?

Very DissatisfiedDissatisfiedNeutralSatisfiedVery Satisfied

Why haven't you sought out professional legal assistance?

Money: I think it will cost too much money.Fear: I'm afraid to talk to someone about my situation. Lack of Information: I don't know where to find one.No need: I don't need professional legal assistance.Other

Other

Temporary Protected Status (TPS) and Deferred Action for Childhood Arrivals (DACA)

Have you ever had or currently have Temporary Protected Status (TPS)?

YesNo

Have you ever had Deferred Action for Childhood Arrivals (DACA)?

YesNo

What is the status of your DACA?

Valid DACA. Not Expired.DACA renewal applicant. Submitted.DACA renewal applicant. Approved. DACA renewal applicant. Denied.Expired DACA

When does your current DACA expire?

Please use the format: MM/DD/YYYY.

What date was your most recent DACA request approved?

MM/DD/YYYY. This date can be found on the I-797, Notice of Action form that was sent to you or on your most recent work authorization card (work permit). If you don't remember, please enter the date as you best remember.

If you renewed your DACA at any point, please list the periods of time you have had DACA.

Example: December 15, 2012-December 14, 2014 AND December 10, 2014-December 9, 2016. Put N/A if this question does not apply to you. If you have specific questions regarding DACA, please write them on the "Any questions you would like us to address?" section at the end of the intake.

Why didn't you apply to Deferred Action for Childhood Arrivals (DACA)?

I didn't know what it was.I didn't think I was eligible.It was too late and/or the program was ended.I didn't think I needed it because I have a better immigration option. I wanted to, but it was too expensive, too risky, or other reason.I did not want DACA. Other

Other

max: 200 words

DACA Expiration Length

How long has it been expired? (i.e. 6 months, a year, etc.)

Page 7

Entries and Exits

Date of first entry into the U.S.

Please enter date as you best remember. Use the format MM/DD/YYYY

What was your method of entry when you first entered the U.S?

No visa, no parole, no inspection, no permission, no papers (i.e. illegally)With my own visa (or with parole)On the Visa Waiver Program and my valid passportUsed someone else's visa or passport or the other identity documentNot sure

No visa, no parole, no inspection, no permission, no papers (i.e. illegally)

I was stopped, detained or denied entry (i.e. caught the first time I tried)I was never stopped, detained or denied entry (i.e. was NEVER caught by border patrol)I don't know if I was stopped when I tried to enterOther

Other

Used someone else's visa or passport or other identity document

And was stopped or denied entry (I was caught using fake papers)And was allowed in the country after being inspected (border patrol did not realize I used fake papers)I don't know if I was stopped when I tried to enter using fake papersOther

Other

VISA Type

What type of visa did you enter the U.S. with most recently?

I'm not sureA Diplomats and foreign government officialsA-2 Foreign military personnel stationed in the U.S.B-1 Business visitors, athletes, domestic employees or nanniesB-2 Tourism, vacation, pleasure or medical treatment visitorsBCC Border Crossing Card: MexicoC Transiting the United StatesD CrewmembersE Treaty traders/treaty investorsE-3 Australian professional specialtyF Students: academic, vocationalG1-G5 Employees of a designated international organization, and NATOH-1B Specialty occupations or physicianH-1B1 Free Trade Agreement (FTA) Professionals: Chile, SingaporeH-2B Temporary workers performing other services or labor of a temporary or seasonal natureH-3 Training in a program not primarily for employmentI Media, journalistJ Professor, scholar, teacher, exchange visitor, physicianL Intrac ompanytransfereesM Students: academic, vocationalNATO16 Foreign military personnel stationed in the U.S.O Foreign nationals with extraordinary ability in Sciences, Arts, Education, Business or Athletics P Performing athletes, artists, entertainersQ International cultural exchange visitorsR Religious workersT Victims of Human TraffickingTN/TD NAFTA professional workers: Mexico, CanadaU Victims of Criminal Activity

If you OVERSTAYED your visa, when did it expire?

The length of visa validity may be different from the 'authorized duration of stay' period. For example, you may have overstayed your short 30-day 'duration of stay' in 2014, even though your B-2 Tourist Visa is valid for 10 years and in your passport does not appear to expire until 2024. Look at your passport to find your 'duration of stay' stamp. More information at: http://travel.state.gov/content/visas/en/general/visa expirationdate.html. (Mark N/A if this does not apply to you or if you are not sure.)

Have you traveled outside the U.S. (even for a short period of time) since you first entered?

YesNo

Travel outside the United States

List EACH trip you made outside the country. Provide date of departure, date of re-entry, and whether you re-entered with a visa, parole, advance parole, the visa waiver program, or unlawfully

How did you most recently enter the U.S.?

With a visa (e.g. B2 Tourist, F Student, etc.) Unlawfully (e.g. crossed the border without inspection) On the Visa Waiver Program With Advance ParoleOther

Other

VISA Type

What type of visa did you enter the U.S. with most recently?

If you OVERSTAYED your visa, when did it expire?

Family and Significant Others

We use this section to help determine whether your family member might be able to file a petition (immigration application) for you or whether you might be eligible as a derivative on another petition. If these questions make you uncomfortable or you do not wish to disclose this information, you may select "choose not to state" but know that it might change our analysis.

What is the immigration status of your PARENTS?

Please answer for each of your parents. Note: A Lawful Permanent Resident (LPR) is someone who has a green card and has permission to live indefinitely in the U.S. but they are NOT YET a U.S. Citizen

Parent 1

Biological father Step-fatherStep-motherBiological mother OtherExamples for other would be: legally-adopted parent, informally adopted parent (no court-order), aunt, uncle, grandparent, sibling, family friend, etc.

Other

Parent 1

Choose not to state Undocumented (No lawful status)Not present in the USLawful Permanent Resident (Green Card Holder) U.S. CitizenOther legal status (explain)Other legal statuses could include: Temporary Protected Status (TPS), U-Visa pending petition, etc.

Other

Parent 2

Other

Parent 2

Other

Parent 3

Other

Parent 3

Other

Parent 4

Other

Parent 4

Other

Do you have any grandparents that are U.S. citizens?

NoYesI don't knowChoose not to state

Children

Do you have any CHILDREN?

Yes No

Are any of your CHILDREN U.S. Citizens?

YesNo

Please list each child's date of birth

Are any of your CHILDREN Lawful Permanent Residents?

YesNo

Please list each child's date of birth

Siblings

Do you have any siblings?

YesNo

Are any of your siblings U.S. citizens?

YesNo

Please list your U.S. citizen sibling's age(s)

Are any of your siblings lawful permanent residents?

YesNo

Please list your lawful permanent resident sibling's age(s)

Significant Others

Are you legally married?

YesNo

Have you been married for more than two (2) years?

YesNoNot sure

Are you engaged?

YesNo

What is the immigration status of your spouse or fiancé/fiancee?

Undocumented (no lawful status)Lawful permanent resident (green card holder)Lawful permanent resident (green card holder) and member of the U.S. Military (active or veteran)U.S. citizenU.S. citizen and member of the U.S. Military (active or veteran)Other

Other

LGBTQ

Do you identify as a member of the Lesbian, Gay, Bisexual, Transgender, Queer (LGBTQ) community?

YesNoI don't feel comfortable answering this

Education and Career

Are you currently attending school in the U.S.?

YesNo

What type of school are you currently attending?

Public or Private High SchoolEducation, Literacy, or Career / Vocational Training ProgramCommunity CollegePublic or Private College or UniversityPublic or Private Graduate / Professional SchoolOther

Other

When do you expect to graduate?

Please select the HIGHEST degree that you have obtained

NoneHigh School DegreeGeneral Education Development (GED) CertificateAssociate's DegreeBachelor's DegreeMaster's DegreeDoctoral DegreeOther

Other

What is (or was) your intended major/focus of study?

N/AAnthropology Agriculture ArchaeologyArchitect and design Area studies BusinessChemistryComputer sciencesCultural and ethnic studiesDivinityEarth sciencesEconomicsEducationEngineeringEnvironmental studies and forestryFamily and consumer scienceGender and sexuality studiesGeographyHealthcare scienceHistoryHuman physical performance and recreation Journalism, media studies and communication LawLibrary and museum studiesLife sciencesLinguisticsLiteratureLogicMathematicsMilitary sciencesPerforming artsPhilosophyPhysicsPolitical sciencePublic administration PsychologyReligionSocial work SociologySpace sciences Statistics Systems science Transportation Visual Arts If your intended major/focus of study is not in this list, choose the one that best resembles yours

What type of career do you intend to pursue?

Previous Immigration Application

Please do research before answering the following questions (talk with your parents, grandparents, aunt/uncle, and review old immigration papers). It can be essential to know the exact date and/or receipt number of an old application. Sometimes a receipt number and filing date can be helpful even if the old case was denied.

Has a relative or employer ever filed an immigration application for you or your parents?

YesNo Not SureExample: This could be your spouse, grandparent, aunt or uncle, sibling, or your adult child. Please make a special note if you think that the application was under an immigration law called "245(i)" or "LIFE Act" or the "Bracero program." You can tell us if you know for sure or if you aren't sure under the “Additional Information” section below.

Who was the petitioner (person who filed the application)?

My US Citizen parentMy US Citizen aunt/uncleMy US Citizen siblingMy US Citizen spouseMy US Citizen grandparentMy Lawful Permanent Resident parent My Lawful Permanent Resident spouse My employerMy parent's employer OtherPlease select one. If there have been multiple application filed, there will be space below where you can add information about the other applications.

Other

Was the aplication filed BEFORE May 1, 2001?

YesNoI don't know / Not sure

What was the date this application was filed?

This date, also known as the Priority Date, can be found on the approval form (i.e I-797) that USCIS (formerly known as INS) sends out when an application is filed. If you can't remember the exact date, you can give us an approximate date. (50 word limit.)

If application was filed after January 14, 1998 and before May 1, 2001, was the principal beneficiary in the U.S. on or before December 21, 2000?

YesNoNot sureThe principal beneficiary is the person whose name appears on all forms sent by USCIS (formerly known as INS) when an application is filed

Did this application get a receipt issued by USCIS (formerly known as the INS), even if the application was ultimately denied?

YesNoNot sureUsually USCIS or INS sends a confirmation receipt notifying receiving the application

If you have the Notice of Approval form(s) of your application(s), what is the receipt number(s)

The 13-character application receipt number can be found on application notices you have received from United States Citizenship & Immigration Services (formerly known as Immigration and Naturalization Services). It begins with three letters such as (EAC, WAC, LIN, or SRC).

Additional Information: Please provide any additional information about this application that would help us in providing you with legal information about your situation.

If additional applications were filed for you or your parents, please summarize those here:

Example: I had a different application also filed by my mother’s sister on May 30, 2001 and the receipt number is EAC-111-2222. The application is currently pending.

Screening for Humanitarian-Based Immigration Remedies

The following information may be sensitive. We use the answers to these questions to determine whether to send you important information about certain humanitarian-based immigration remedies which may be of interest to you. We do not share personal information with anyone outside of E4FC's Legal Services Team. There is a section later in this intake form under "Additional Information" where you may request that your intake form be seen by or excluded from a specific person on the E4FC Legal Services Team or provide any other additional requests about how your sensitive information is handled. Please Note: Our Immigration Attorney and Legal Services Coordinator review all intake submissions.

Have YOU ever been the VICTIM OF A SERIOUS CRIME in the U.S. which SOMEONE reported to the police?

YesNoI don't feel safe/comfortable answering thisExamples of serious crimes include: abduction, abusive sexual contact, blackmail, domestic violence, dating violence, stalking, extortion, false imprisonment, female genital mutilation, felonious assault, hostage, incest, involuntary servitude, kidnapping, manslaughter, murder, obstruction of justice, peonage, perjury, prostitution, rape, sexual assault, sexual exploitation, slave trade, torture, trafficking, witness tampering, unlawful criminal restraint, etc.

Have any of your SIBLINGS ever been the VICTIM OF A SERIOUS CRIME in the U.S. which SOMEONE reported to the police?

YesNoI don't feel safe/comfortable answering this Examples of serious crimes include: abduction, abusive sexual contact, blackmail, domestic violence, dating violence, stalking, extortion, false imprisonment, female genital mutilation, felonious assault, hostage, incest, involuntary servitude, kidnapping, manslaughter, murder, obstruction of justice, peonage, perjury, prostitution, rape, sexual assault, sexual exploitation, slave trade, torture, trafficking, witness tampering, unlawful criminal restraint, etc.

Have you ever witnessed a crime?

YesNoI don't feel safe/comfortable answering this

Have you ever been the victim of domestic violence, abuse, or threats?

YesNoI don't feel safe/comfortable answering this

Have you ever been "abandoned, abused or neglected" by EITHER of your parents?

YesNo I don't feel safe/comfortable answering thisExamples of the “abandoned, abused or neglected” include, but are not limited to: a child whose parents are deceased and whose adult sibling or other relative is caring for her; a child who experienced domestic violence in the home and who is living with an extended relative or family friend; a child who was abandoned by his parents and who now lives in a foster home; a child who was abused by one parent and who is living safely with the other parent or another family member.

Have you ever had to live with someone other than your parent(s)?

YesNo

If yes, with whom did you live with and when (what age)?

Did you live with someone IN ADDITION or INSTEAD OF your parents?

Have you ever been in juvenile delinquency or dependency court?

YesNo I don't feel safe/comfortable answering thisJuvenile judges hear cases where either the child has been accused of a crime or the parent/ guardian has been accused of not properly caring for the child.

Do you have to or have you had to meet with a juvenile probation officer, juvenile judge, or county social worker?

Are you AFRAID OF RETURNING to your country of origin/country of birth?

YesNo I don't feel safe/comfortable answering this

If you answered YES to any of the above, please provide as many details as you feel comfortable sharing and let us know which question you are referring to.

For example, “I experienced abandonment by my biological mother when I was 6 years old….”

T-Visa Screening

Did anyone recruit you in your home country to work in the United States?

YesNoI don't feel safe/comfortable answering this

Have you ever felt forced to work or tricked into working?

YesNoI don't feel safe/comfortable answering this

Were you ever required to work without pay (or less pay than expected or required by law)?

YesNoI don't feel safe/comfortable answering this

Have you been forced or tricked to do a sexual act for money, food, or other reason?

YesNoI don't feel safe/comfortable answering this

Contact with Customs & Border Patrol (CBP) or Immigration & Customs Enforcement (ICE)

If you have a pending immigration deportation case or upcoming hearing and do not have an immigration attorney representing you, visit www.immigrationlawhelp.org or www.AILAlawyer.com to find one. You should also find legal help before applying for any future immigration benefit if you were ever deported or detained by ICE or CBP. E4FC does NOT provide legal representation and our services are not intended for emergency situations and you may not receive a response from us for several weeks.

Were you ever stopped at the border trying to cross into the U.S.?

YesNoI don't feel safe/comfortable answering this

Please explain what happened:

Have you ever been confronted by an Immigration & Customs Enforcement (ICE) officer?

Yes NoI don't feel safe/comfortable answering this

Please described what happened:

If the Immigration & Customs Enforcement (ICE) officer ever confronted you at a home, workplace or other similar location, who gave them permission to enter?

N/A I was not confronted by an ICE officer at a home, workplace or similar location MeSomeone in my familySomeone who does not live in the homeNo one, they broke down the doorNo one, they knocked but they were not let inNo one, they stopped knocking, but then arrested me once I left the locationOther

Other

Removal/Deportations

Are you currently (or have you ever been) in IMMIGRATION COURT (i.e. removal/deportation proceedings)?

Yes No Not Sure I don't feel safe/comfortable answering thisOther

Other

Were you ever ordered, removed or deported?

YesNoNot sureI don't feel safe/comfortable answering this

If you are currently in deportation/removal proceedings, when is your next court date?

Skip this question if it does not apply to you.

If you are no longer in deportation/removal proceedings, what was the final outcome of your case?

Skip this question if it does not apply to you

What is your ALIEN REGISTRATION NUMBER (A#)?

Criminal Background

Have you ever been arrested or accused of a crime, even if you were never arrested?

Yes NoI don't feel safe/comfortable answering this

Have you ever received a ticket or been convicted of any crime, other than for a minor traffic offense?

Yes NoI don't feel safe/comfortable answering this

Have you ever been in juvenile delinquency court?

Yes NoI don't feel safe/comfortable answering thisA juvenile delinquency court is where a person is charged as a minor for some offense, or had to spend time in juvenile hall, or be on juvenile probation

Have you ever been convicted of a felony?

Yes NoI don't feel safe/comfortable answering thisA felony is a federal, state or local criminal offense where a person could be sentenced to 366 days or more of imprisonment, even if you received a shorter sentence, or the sentence was suspended by a judge.

Have you ever been convicted of a misdemeanor?

Yes NoI don't feel safe/comfortable answering thisA misdemeanor is a federal, state or local criminal offense where a person could be sentenced to between 6 and 365 days or less of imprisonment, even if they got a shorter sentence, or the sentence was suspended by a judge.

If you answered YES to any of the above, please describe what happened:

Feedback

Did someone help you fill out this Immigration Legal Intake Service?

YesNo

Who helped you fill out this Immigration Legal Intake Service

ParentSiblingFriendTeacher or CounselorOther

Other

How confident are you about the accuracy of the information you provided?

Not at all confidentNot confidentNeutralSomewhat confidentConfident

Were there any particular questions that you found difficult to understand or answer?

YesNo

Please describe the question(s) that you found difficult to understand or answer?

Were there any specific questions that made you feel uncomfortable and/or unsafe answering?

YesNo

Please describe the question(s) that you found uncomfortable and/or unsafe answering and why.

Do you have any questions that you would like us to address?

How long did it take you to complete this intake?

Less than 10 minutes 10-20 minutes20-30 minutes30 minutes-1 hour More than an hour

Please let us know if there is anything else that we can do to improve this service. We would also appreciate any positive feedback that you have to share with us!

Remember, it may take us a few weeks to process depending on our capacity.

You’re not done yet! Please press "SUBMIT."

Please press ‘SUBMIT’ below to finish your intake. Our Immigration Law Services Team (legalintake@immigrantsrising.org) will notify you via email when we have begun processing your intake and may contact you if we have any questions.

When we have completed our review, we will email you from legalintake@immigrantsrising.org and send a text from our phone number (415) 787-3432. Please note that our email may appear to come to you via a salesforce.com email address.

If you have further questions about the Immigration Law Intake Service, feel free to contact us at: legalintake@immigrantsrising.org.

Immigrants Rising, Immigration Law Services Team

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