Recognized Car Company

SCOTT D. POLLOCK & ASSOCIATES, P.C.

105 W. MADISON, SUITE 2200

CHICAGO, IL 60602

Telephone: 312-444-1940

Fax: 312-444-1950

DATE: ATTORNEY: ___

U.S. Immigration Questionnaire

Please complete this form as thoroughly as possible so we can understand your needs and develop an appropriate U.S. immigration strategy for you. Not all questions will relate to you or your situation, but the more information you can provide, the better we can assess your case. Feel free to use additional pages if necessary to fully answer a question. When you finish, please sign this form. You must also notify us if any of your answers to these questions change in the future.

*** Any information you provide on this questionnaire will be used solely for Scott D. Pollock & Associates to evaluate your case and will NOT be disclosed in part or its entirety to any private or government agencies. ***

First, why have you come to see us? (e.g. do you want a particular nonimmigrant visa, a change or extension of status, lawful permanent resident status, temporary or permanent employment authorization, U.S. citizenship, defense from deportation, political asylum etc.):

______________________________________________________________________________

______________________________________________________________________________

[To be filled out by person accompanying foreign- born person, if none, leave blank.]

Your Name (if not the foreign-born person): _________________________________

Relationship to the foreign-born person: ____________________________

Telephone: ________________________

E-mail: ___________________________

A. Information of Foreign-born person

Name:_______________________

Date of birth: _____________________

Place of birth: _____________________

Address:

Telephone: (home) ___

Cell phone: ___

Fax number: ______________________________________

E-mail address: ___

Social Security # (if any)...