Family Background
General background about your immediate family, regardless of where they currently live.
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Address History
Please list all places you've resided for the past five years.
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Most recent address outside the U.S. (if different from above)
Immigration & Court History
Have you ever been ordered removed or deported from the U.S.?
Select Yes No
Have you ever been in immigration court?
Select Yes No
Have you ever been stopped by immigration officials?
Select Yes No
If yes to any of the above, please describe
Have you ever applied for any immigration benefit?
Examples: permanent residency, asylum, amnesty, TPS, cancellation, suspension, Family Unity, DACA, visa petition, U visa, T visa, SIJS, or any other benefit.
Select Yes No
Has an organization or attorney ever helped file paperwork on your behalf?
This means prior help from a legal aid organization, notario, or another attorney — not a family member.
Select Yes No
Family
Spouse or Domestic Partner Information (if applicable)
Children
List each child below. Use "+ Add another child" for more, or "Remove" to delete a row.
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Are there other family members relevant to your case?
This could include family members you already mentioned above, if their status or presence in the U.S. is relevant here too.
Select Yes No
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Memberships
Organizations, churches, associations, or unions you've belonged to. This can matter for certain types of cases, including asylum.
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Background & Safety Screening
These questions help us identify protections you may be entitled to, such as asylum, U visas, T visas, or VAWA relief.
Have you ever had trouble with the police or been arrested in the U.S.? If so, when, for what, and what sentence did you receive?
Do you have any reason to fear going back to your country? Who do you fear, and why?
Have you ever been a victim of domestic abuse, or been threatened or harmed, by a family member?
This could be a spouse, a parent, a child, or another family member — the aggressor doesn't have to be your spouse.
Select Yes No
Have you ever been the victim of a crime? If so, what crime?
If so, did you report it to police or help with the investigation/prosecution?
Select Yes No
Did anyone recruit you in your home country to work in the U.S.?
Select Yes No
Did you feel forced or tricked into working?
Select Yes No
Were you required to work without pay, or less pay than allowed/expected?
Select Yes No
Have you been abandoned, abused, or neglected by a parent? Are you currently under the jurisdiction of a juvenile court (dependency, delinquency, or probate guardianship)?
Select Yes No
