53 West Jackson Blvd, Suite 1340

Chicago, IL 60604

TEL: (312) 362-9844

Schedule a Consultation

Persons seeking legal representation should schedule a telephone or in-person consultation with Attorney Ebere N. Ekechukwu.

For persons seeking immigration legal assistance, please complete the following form in its entirety. If you are seeking any other type of legal assistance, you are only required to fill out the INFORMATION ABOUT YOU section of the questionaire. When you are done, please sign and date the STATEMENT OF TRUTHFULNESS section and send it to our office by clicking the button marked "Send Questionnaire" at the end of the form.

Please fax any documents relevant to your case to us prior to your consultation at (312) 362-9877.

The information contained in the form should be about the person who is seeking the legal assistance.

Wait a few minutes after you send the questionnaire, then call us at (312) 362-9844 to schedule your consultation.

All information contained in this Legal Consultation Form will be kept STRICTLY CONFIDENTIAL.

INFORMATION ABOUT YOU

Name

Last: First: Middle:

Other names used (including maiden name): Sex:

E-mail address:

Current Address in U.S.
Number and Street:
City:		State:	Zip:
Last Address Outside of U.S.
Number and Street:
City:	State/Province: Postal Code:
Country:

Home Phone:
Hours we can call:
Fax Number:

Work Phone:
Hours we can call:
Pager/Cell Phone:

Social Security No:

Citizen of:

Date and Place of Birth:
Date of Birth:
City or Town:
State or Province:
Country:

Passport Information:
Passport Country:
Passport Number:
Expiration Date:

What type of legal assistance are you seeking?

FAMILY INFORMATION

Husband or Wife In the U.S. Outside of U.S. Unmarried

Spouse's Name
Last: First: Middle:
Other names used (including maiden name):

Current Address (put "same" if you live together):

Date and Place of Birth:
Date and Place of Marriage:
Citizen of:
Applying with you?

Social Security Number:
Alien ("A") Number:
Immigration Status:
Expiration Date:

Children

Total Number of Sons and Daughters:

Name	Sex	Date & Country of Birth	Citizen of	Immigration Status	Expiration Date	Applying with You?

Parents

	Name	Country of Birth	Citizen of	Immigration Status
Your Father:
Your Mother*:
Spouse's Father:
Spouse's Mother*:
* Use Mother's Maiden Name

Previous Marriages ( Check if Not Applicable)

	Name	Date of Marriage	Country of Marriage	Kids?	Reason for Termination of Marriage	Date of Termination of Marriage	Country of Termination of Marriage
Your's:

Spouse's:

IMMIGRATION HISTORY

Current Immigration Status:	Date Status Expires:	Alien ("A") Number:
Date of First Entry into U.S.:	Last Entry into U.S.:	I-94 Number:

Check every type of immigration status that you have ever held and provide the dates:

Immigration Status	Date(s)	Immigration Status	Date(s)
B Visitor:		E Trader/Investor:
F Student:		H-1B Professional:
J Exchange Visitor:		K Fiancee:
L Manager:		O Outstanding Ability:
T/N Canadian Worker:		Other:

Check each one that you or your spouse have ever applied for or been the beneficiary of:

Y(You) or S(Spouse)		Date Filed	Sponsor	Attorney	Result
	Green Card
	Immigrant petition
	Labor certification
	Asylum
	Amnesty

Have you or your spouse ever had any immigration problems? In particular, have you or your spouse ever been under removal,
deportation, or exclusion proceedings? Please describe in detail:

EMPLOYMENT HISTORY

Current Employer (or Employer Petitioning on Your Behalf)

Employer:
Address:
Job Title:		Salary:
Date of Hire:	Are you related to your employer?

May we contact your employer?
If yes, whom may we contact:

Name	Title	Department	Phone Number

Employment in Last Five Years (anywhere in the world)

Job Title	Employer	Country	Duration

JOB QUALIFICATIONS

List the professional licenses or certifications you possess, from any state or country:

How many years of experience do you have in your position or field?

EDUCATIONAL BACKGROUND

Please list all your education anywhere in the world:

Level	School/Country	Degree & Major	Number of Years	Graduate?
College/University:
College/University:
Other Schooling:

OTHER INFORMATION

Have you ever been arrested or convicted of a crime anywhere in the world (even if the conviction was expunged or removed from your record) or have you ever had any problems with the police?
If yes, please explain in detail:

Have you ever claimed to be a citizen of the United States or have you ever used another name
for immigration purposes or for any other reason?
If yes, please explain in detail:

Have you ever been denied a visa to come to the United States?
If yes, when and what kind of visa:

During what years, if any, have you filed an Income Tax Return with the IRS?

If you ever had an Employment Authorization Card issued by the INS, give number(s) and validity dates:

Is there anything, not already covered in this form, that you feel we should know?

STATEMENT OF TRUTHFULNESS

"By pressing the Send Questionnaire button below,
I certify that I have read and understood the instructions above this questionnaire.
I certify that all of the information contained in this form is true and correct to the best of my knowledge."

Type your name

Type today's date