All fields with asterisks (*) are required

Salutation *	--None--Mr. Ms. Mrs. Dr. Prof.
First Name *
Last Name *
E-mail *
How Did You Find Us?:	--None--Former client Other attorney Internet Search Saw one of your articles Legal Seminar Other
Your State/Province *	--None--Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming
Fiancee's Country of Citizenship *	--None--Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Barbuda Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire Bosnia Botswana Brazil British Virgin Islands Brunei Bulgaria Burma Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Rep Chad Channel Island Chile China Colombia Congo Cook Island Costa Rica Croatia Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Faeroe Island Fiji Finland France French Guiana French Polynesia Polynesia Gabon Gambia Georgia Germany Ghana Gibraltar Great Britain Greece Greenland Grenada Guadeloupe Guatemala Guinea Guinea Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iraq Iran Ireland Northern Ireland Northern Israel Italy Ivory Coast Jamaica Japan Jordan Kazakhstan Kenya Korea Kuwait Kyrgyzstan Latvia Laos Lebanon Liberia Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Reunion Romania Russia Rwanda Saba Saipan Saudi Arabia Scotland Senegal Serbia Seychelles Sierra Leone Singapore Slovac Republic Slovenia South Africa South Korea Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Trinidad-Tobago Tunisia Turkey Turkmenistan United Arab Emirates Emirates Uganda Ukraine United Kingdom Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Wales Yemen Zaire Zambia Zimbabwe
Petitioner's marital status:	--None--Never Married Divorced Married Separated Divorce underway Widowed
Case Facts and Situation *
Most Recent Meeting with Fiance(e) *	--None--Within last three months Three months to six months ago Six months to one year ago More than a year ago Never met
Fiance(e)'s First Name
Total time spent in fiancee's company:	--None--Over two months One month to two months Two weeks to one month One week to two weeks One day to seven days None
Your Occupation *
Your Phone Number *
Your Number of Marriages
Your Age:
Fiance(e)'s Age
Your Income (AGI from last tax return)
Your # of Dependents
Ever Sponsored Anyone for a U.S. Visa	--None--Yes No
Fiance(e) Ever Overstayed a U.S. Visa?	--None--Yes No Not sure
Fiance(e) Ever Had Another U.S. Fiance(e)?	--None--Yes No Not sure
Fiance(s) Ever Denied a U.S. Visa?	--None--Yes No Not sure
Fiance(e)'s English Level	--None--Excellent Very Good Good Fair Poor None
Fiance(e)'s Marital Status	--None--Never Married Divorced Divorce underway Separated Widowed Married
Fiance(e)'s # of Prior Marriages
Fiance(e)'s # of Children
Father's consent to child moving to USA	--None--Have it in written form Have it verbally Do not have it, but can get it Can not get it
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