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Reston, VA | Washington, DC
Client Forms
Law Offices of
Mark A. Urbanski PLLC
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Work Visas
Employment-based green cards
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Home
About
Practice Areas
Work Visas
Employment-based green cards
G-4 Visas & Diplomats
EB-5 Investment-Based Immigration
Family-Based Immigration
Waivers
Removal Defense
Political Asylum
TPS & DACA
Naturalization
Recruiters Corner
Students & Visitors
News
Links
Contact Us
Schedule a Consultation
Home
About
Practice Areas
Work Visas
Employment-based green cards
G-4 Visas & Diplomats
EB-5 Investment-Based Immigration
Family-Based Immigration
Waivers
Removal Defense
Political Asylum
TPS & DACA
Naturalization
Recruiters Corner
Students & Visitors
News
Links
Contact Us
Menu
Home
About
Practice Areas
Work Visas
Employment-based green cards
G-4 Visas & Diplomats
EB-5 Investment-Based Immigration
Family-Based Immigration
Waivers
Removal Defense
Political Asylum
TPS & DACA
Naturalization
Recruiters Corner
Students & Visitors
News
Links
Contact Us
Client Intake Form
Please fill out this form with the information of the person requiring immigration assistance.
Please enable JavaScript in your browser to complete this form.
Personal Information:
Date
Name
*
Alien# (if any)
Birth Date
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1921
1920
Place of Birth
Country(ies) of Citizenship
Social Security No
Address
Telephone Numbers (Home)
Telephone Numbers (Work)
Telephone Numbers (Cell)
*
E-mail address
*
Employment:
Company Name
Work From
DD
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MM
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YYYY
2023
2022
2021
2020
2019
2018
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2015
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2012
2011
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1961
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1921
1920
Work To
DD
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31
/
MM
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10
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12
/
YYYY
2023
2022
2021
2020
2019
2018
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2015
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2011
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1981
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1972
1971
1970
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1968
1967
1966
1965
1964
1963
1962
1961
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1953
1952
1951
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1949
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1931
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1920
Company Address
Position
Duties
Current visa status
Visa Expires
Status at time of Last Entry Date
DD
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MM
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YYYY
2023
2022
2021
2020
2019
2018
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2016
2015
2014
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2011
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2001
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1998
1997
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1991
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1989
1988
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1984
1983
1982
1981
1980
1979
1978
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1976
1975
1974
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1972
1971
1970
1969
1968
1967
1966
1965
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1963
1962
1961
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1953
1952
1951
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1949
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1935
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1931
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1921
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Status at time of Last Entry Place
Have you or anyone else filed an immigration petition on your behalf before?
Yes
No
Have you ever been arrested or detained by the police or an immigration official?
Yes
No
Have you ever been refused entry to the U.S. or been in a deportation proceeding?
Yes
No
Do you have any U.S. Citizen or Permanent Resident relatives in the U.S.?
Yes
No
Please Elaborate or Describe
Family Members:
Relationship
Name
Date of Birth
DD
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MM
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YYYY
2023
2022
2021
2020
2019
2018
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2016
2015
2014
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2012
2011
2010
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2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
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1949
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1932
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1930
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1927
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1924
1923
1922
1921
1920
Country of Birth
U.S. Immigration Status
Spouse/Fiance
Child#1
Child#2
Child#3
Child#4
Briefly describe the assistance desired:
How did you hear about the Law Offices of Mark A. Urbanski?
Consultation fee is $250.00 for up to 1 hour in-office or $200.00 for telephone or video consultation. ($150.00 reduced fee for employees/dependents of The World Bank, IMF, IFC, IDB, PAHO and U.S. military/veterans)
Payment Options:
Cash
Cash (in person Consultation only) __Zelle (send to urbanski@globecenter.com) (Please pay when returning this form)
Credit/Debit (Visa, MC or Discover) Card
Exp. Date
CVV Code
E-check: Routing No
Account No
Acct. Holder
Signature to authorize payment of Consultation Fee
Date
Notes and Elaboration:
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