UVISA and VAWA Intake Form

Immigration UVISA/VAWA Client Intake Form

Please complete the following form and submit the necessary documents if you are interested in a UVISA/VAWA consultation.

The consultation cost is $150 and is nonrefundable. It must be submitted before a consultation will be scheduled. Any additional costs of the process will be explained during the consultation and will vary from case to case.
To be considered for a consultation, all of the information must be completed, along with the submission of the necessary documents. Please save any questions for your consultation with the attorney. You will be contacted by staff to schedule a consultation and confirm the information you provided. These staff members are not attorneys and will not be able to answer any questions about the process.

Name*

First NameMiddle NameLast Name
Date*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Birth Date*

MonthDayYear
Phone Number*
This is my:*
E-mail
Language Preferred for Intake and Consultation*

SpanishEnglishOther
It is safe to contact me through:*

PhoneEmailText MessageOther
Provide best time availability to contact you. Our hours of operation are Monday through Friday 9 am - 5 pm - excluding holidays*
I have completed this form before and I am returning to submit my police report*

YesNo