Immigration Intake Form Name * First Name Last Name Email * Phone * Country (###) ### #### Describe nature of service needed. * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Current Immigration Status * US Citizen Lawful Permanent Resident Alien Non-Immigrant Alien Immigrant Alien Undocumented Alien US National Student Visa Tourist Visa Temporary Protected Status Asylee Parolee Out of status Other Date of birth * MM DD YYYY Country of birth * Marital Status * Married Single Date of Entry to US MM DD YYYY I-94 Number Nationality * If employed, how much do you make a year? * If not employed you can answer with $0 $ Do you have an attorney? * Yes No How did you hear about us? * Social Media Nigerian Center Event Online Ad Partner Organization of Nigerian Center Other Referred by: Would you like to donate $1 or more to support our immigration services? * Yes No I understand that the Nigerian Center provides access to Attorneys for the purpose of providing legal services, and the Nigerian Center is not a law firm. Attorneys working with the Nigerian Center will keep all identifying information confidential. The Attorney that I consult with on the date of my consultation may provide limited legal advice as part of the free consultation. This does not create an attorney client relationship for the purposes of full representation. I may meet with a Nigerian Center staff member or volunteer who is not a lawyer. I understand that he or she will not be providing legal advice and any conversation with such staff member or volunteer is not legal advice. * Yes Yes Thank you for completing our immigration in-take form. One of our immigration specialist will be contacting you shortly. Fees: A $85 fee will be charged to register for our immigration services
