Ticket Number

Please refer to the email previously sent from the IRP with a link to this form and a ticket number.

What is your deadline?

PDP Email Address

PDP Phone Number

Phone Extension

CLIENT INFORMATION

Any AKA

Client's Immigration File Number (A Number or AR Number)

The 8 or 9 digit A number can be found on any of the client's immigration documents, or sometimes in an FBI/NCIC/LEDS report under Misc Numbers.

Client's country/countries of citizenship? In what country was client born (if different)?

What language(s) does client speak?

IMMIGRATION SITUATION & HISTORY

Date of First Entry to the U.S.

If yes, what valid immigration documents did client use to enter the U.S.?

If yes, please list the approximate dates of each departure and entry, including the most recent entry. If dates are unknown, please note whether client has ever travelled outside the U.S. for more than 90 days at one time and/or 6 months in the aggregate.

If Visa Holder or Other, please specify.

Date acquired current immigration status, if different than date of entry

Has client ever been turned away or deported at the border? If so, when?

Has client ever been ordered deported by an immigration judge? If yes, when?

Has client received relief from deportation? If yes, provide type of relief and date granted.

E.g., Cancellation of Removal, 212(c) Waiver, Suspension of Deportation, DACA, TPS, etc.

Date of marriage, if applicable

If applicable, immigration status of spouse or partner, e.g. USC, LPR, undocumented

If yes, when did the marriage end?

If yes, what is the immigration status and age of each child?

Do any of client's children (16 years or older) serve or wish to serve in the U.S. military or national guard? If yes, briefly describe.

If yes, how many parents in the U.S. and what is their immigration status?

Does client, or client's spouse, parents or children have any significant health, mental, learning or psychological issues? If yes, briefly describe.

Has client or client's children ever been the victim of a crime, domestic abuse or human trafficking? If yes, briefly describe.

Does client fear harm or death if returned to their home country? If yes, why?

CURRENT CHARGES

For each pending criminal case, please provide copies of the following documents, if available: 1. Discovery 2. Plea offers 3. State and FBI rap sheet Email directly to [email protected] and reference your ticket number in the subject line.

County of Arrest

Case Number(s)

Date(s) Offense(s) Committed

Please list all of the offenses with which client was charged, including classification and Penal Code/Statute number for each charge.

EXAMPLE: Count 1: Petty Theft, ORS § ###, A-Misd. Count 2: Burglary II, ORS § ###, C-Fel

Please give brief description of events that led to arrest.

What is the current plea offer?

Loss or Restitution Amount, if applicable

Age of Minor Victim(s), if applicable

Is there a deadline on an early resolution offer? If yes, when?

PRIOR CONVICTION HISTORY

For each prior OUT OF STATE, MUNICIPAL OR FEDERAL conviction, complete a Prior Conviction section below. If only Oregon state prior convictions, skip to the last section Miscellaneous below.

Prior Conviction #1 (Out of State, Municipal, or Federal)

Including Restraining or No Contact Order Violations, Non-traffic Violations, Traffic Crimes, and Deferred Adjudications. If client has no prior convictions, scroll down to the final section. For each prior conviction, please email copies of the following documents: 1. Charging document 2. Plea 3. Judgment and Sentence/Final Disposition Email directly to [email protected] and reference your ticket number in the subject line.

Date Offense Committed

Case No., City and State of Arrest

County of Arrest

If Other Court, please name.

Please give a brief description of the events that led to arrest, and list all charges by count.

Date of Plea/Verdict

Special Disposition (if applicable)

E.g. pre-plea diversion, post-plea diversion, civil compromise.

Please list all the charges with which client was convicted, including the classification and Penal Code or Statute number for each charge.

EXAMPLE: Petty Theft, PC/ORS/RCW § ###, A-Misd

Date of Sentence

Length of sentence (including probation and parole)?

A sentence is the punishment imposed by the court, even if execution of sentence is suspended.

Loss or Restitution Amount, if applicable

Age of Minor Victim(s), if applicable

How much time did client actually serve in custody?

If yes, what was the result of the appeal?

Post conviction work? If yes, what was the result?

Prior Conviction #2 (Out of State, Municipal, or Federal)

Including Restraining and No Contact Order Violations, Non-Traffic Violations, Traffic Crimes, and Deferred Adjudications. For each prior conviction, please email copies of the following documents: 1. Charging document 2. Plea 3. Judgment and Sentence/Final Disposition Email directly to [email protected] and reference your ticket number in the subject line.

Date Offense Committed

Case No., City and State of Arrest

County of Arrest

If Other Court, please name.

Please give a brief description of the events that led to client's arrest, and list all charges by count.

Date Plea/Verdict

Special Disposition (if applicable)

Please list all the charges with which client was convicted, including classification and Penal Code or Statute number for each charge.

EXAMPLE: Petty Theft, PC/ORS/RCW ###, A-Misd

Date of Sentence

Length of sentence (including probation and parole)?

Loss or Restitution Amount, if applicable

Age of Minor Victim(s), if applicable

How much time did client actually serve?

If yes, what was the result of the appeal?

Post conviction work? If yes, what was the result?

MISCELLANEOUS

Does client have, or has client ever had, an immigration attorney? If yes, please name.

If there are any special concerns or circumstances you think are important for us to know, please describe.

WE RECOMMEND PRINTING THE COMPLETED INTAKE FORM FOR YOUR RECORDS BEFORE HITTING "SUBMIT."

IRP Intake