Model Intake Form For Noncitizen Criminal Defendants printable pdf download

Model Intake Form for Noncitizen Criminal Defendants

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Purpose of document:

This model intake form for noncitizen clients requests the information necessary to conduct a

comprehensive analysis of the potential immigration consequences that may result from a criminal case. Completing the questions on

this form is only the first step; an attorney must still conduct a complete immigration analysis.

General background

Date of birth:______________________________

Place of birth: _____________________________

Country of citizenship: _____________________

Marital status: _____________________________

Children? Y/N Age and immigration status of children:________________________________________________

Is either parent a U.S. citizen or Lawful Permanent Resident (LPR)?:______________________________________

Immigration background

Date of first lawful entry into the U.S.:_____; status at

What is current immigration status?

time of entry:______.

 Undocumented (date of entry:______)

 LPR (green card holder) (date obtained:______)

Date of subsequent lawful entries into the

 Visa holder (type:_________) (exp. date:______)

U.S.:_________; Status at time of entry:______.

 Refugee/asylee

 Temporary protected status (country: _______)

Length of residence in the U.S.?______________; any

 Executive action (e.g. DACA)

absences?__________________.

 Previously ordered deported

COMPLETE Criminal History

First offense:

For each offense, list:

 Statute(s) of conviction

 Date of commission

Second offense:

 Date of conviction

 Type of disposition (plea, deferred disposition,

trial, etc.)

 Sentence given (including any suspended time,

Third offense

time served, probation and parole)

 Time actually served in custody

Key immigration considerations (this is not an exhaustive list):

 Is a deferred disposition possible with not guilty plea and no admissions/stipulations? If so, disposition may not be conviction

for immigration purposes.

 Will case be resolved through juvenile delinquency? If so, unlikely to cause defendant to be removable.

 Does the defendant have TPS? If so, any felony or two misd. (excl. Va. Class 3 and 4 misd.) make defendant ineligible.

 Does case involve controlled substances? If so, severe immigration consequences, regardless of felony or misdemeanor

(possible exception for some marijuana cases).

 Does case involve theft, burglary, bribery, forgery, crimes of violence, obstruction of justice or perjury + sentence of 1

year or more? If so, significant risk of conviction resulting “aggravated felony.”

 Does case involve fraud and alleged loss to the victim > $10,000? If so, significant risk of conviction resulting “aggravated

felony.”

 Is this an offense involving lying, stealing, fraud or recklessly/intentionally causing bodily harm? If so, significant risk of

conviction resulting in “crime involving moral turpitude,” which may lead to deportation depending on other factors.

Model Intake Form For Noncitizen Criminal Defendants

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