Consultation Questionnaire Personal (U.S.)

    We recommend you to download and use the PREVIEW FORM on right. You can also email the filled form as an attachment to: [email protected].
    Call us at 425-259-1807 if you have any questions.

    (* required. If additional space is required, use Additional Message box on the bottom.)

    Your Name (Last, First, Middle)*

    Other Names (Maiden, Religious, Professional, Aliases)

    Date of Birth (Mo/Day/Yr)

    Place of Birth (City, State, Country)

    Citizenship (Country)

    Email*

    Address

    Telephone

    Facsimile

    Marital Status

    MarriedWidowedDivorcedSeparatedSingle

    Spouse’s Name (Last, First, Middle)

    Date of Birth (Mo/Day/Yr)

    Place of Birth (City, State, Country)

    Child 1 Name (Last, First)

    Date of Birth (Mo/Day/Yr)

    Place of Birth (City, State, Country)

    Child 2 Name (Last, First)

    Date of Birth (Mo/Day/Yr)

    Place of Birth (City, State, Country)

    Child 3 Name (Last, First)

    Date of Birth (Mo/Day/Yr)

    Place of Birth (City, State, Country)

    Child 4 Name (Last, First)

    Date of Birth (Mo/Day/Yr)

    Place of Birth (City, State, Country)

    Child 5 Name (Last, First)

    Date of Birth (Mo/Day/Yr)

    Place of Birth (City, State, Country)

    Child 6 Name (Last, First)

    Date of Birth (Mo/Day/Yr)

    Place of Birth (City, State, Country)

    Applicant's College/University Name (1)

    From (Mo/Yr)

    To (Mo/Yr)

    Degree

    Applicant's College/University Name (2)

    From (Mo/Yr)

    To (Mo/Yr)

    Degree

    Applicant's College/University Name (3)

    From (Mo/Yr)

    To (Mo/Yr)

    Degree

    Spouse's College/University Name (1)

    From (Mo/Yr)

    To (Mo/Yr)

    Degree

    Spouse's College/University Name (2)

    From (Mo/Yr)

    To (Mo/Yr)

    Degree

    Spouse's College/University Name (3)

    From (Mo/Yr)

    To (Mo/Yr)

    Degree

    Applicant's Post Secondary Schooling (1)

    From (Mo/Yr)

    To (Mo/Yr)

    Degree

    Applicant's Post Secondary Schooling (2)

    From (Mo/Yr)

    To (Mo/Yr)

    Degree

    Applicant's Post Secondary Schooling (3)

    From (Mo/Yr)

    To (Mo/Yr)

    Degree

    Spouse's Post Secondary Schooling (1)

    From (Mo/Yr)

    To (Mo/Yr)

    Degree

    Spouse's Post Secondary Schooling (2)

    From (Mo/Yr)

    To (Mo/Yr)

    Degree

    Spouse's Post Secondary Schooling (3)

    From (Mo/Yr)

    To (Mo/Yr)

    Degree

    If self-employed, list position.

    Business Address

    Type of Business

    Telephone

    Facsimile

    Email

    Present Occupation

    Present Employer

    Address

    Telephone

    List last three prior employers.

    Prior Employer (1)

    Address

    Telephone

    Prior Employer (2)

    Address

    Telephone

    Prior Employer (3)

    Address

    Telephone

    Do you have any U.S. citizen relatives?

    YesNo

    If so, list their relationship to you and status.

    Relative 1 Name (Last, First)

    Relationship

    Immigration Status

    Relative 2 Name (Last, First)

    Relationship

    Immigration Status

    Relative 3 Name (Last, First)

    Relationship

    Immigration Status

    Relative 4 Name (Last, First)

    Relationship

    Immigration Status

    Relative 5 Name (Last, First)

    Relationship

    Immigration Status

    Relative 6 Name (Last, First)

    Relationship

    Immigration Status

    Where were your grandparents born?

    Have you ever applied for a visa to the U.S.?

    YesNo

    If yes, list the type of visa:

    Outcome?

    GrantedDenied

    Date visa was issued:

    Have you ever been arrested for any crime, regardless of whether charges were filed or whether you were found innocent?

    YesNo

    Additional Message

    By checking the box below I certify that the information provided on this questionnaire is true and correct to the best of my knowledge.

    [recaptcha size:compact]

    IMPORTANT: Review all sections carefully before submitting.