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Consultation Request Form

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Personal Information

Salutation

First Name *

First name is required

Last Name

Gender

Date of Birth

Email *

Valid email is required

Mobile Number *

Mobile number is required (at least 10 digits)

Phone (Alternative)

Please select one or many preferred languages

Applicant's Photo

Optional. JPG, PNG or WebP. Used for your profile.

Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Organization (Optional)

Organization Name

Website

Industry

Number of Employees

Annual Revenue

Immigration Details

Country for Immigration *

Please select country for immigration.

Current Immigration Status *

Please select current immigration status.

Status at Time of Entry *

Please select status at time of entry.

What is Current Country of Citizenship *

Please select current country of citizenship.

When did you last enter the United States? *

Please select date of last entry.

Please select one or many the type of immigration matter you would like to discuss (at least one) *

Please select at least one immigration matter.

Comments on immigration matter (optional)

Have you ever filed any immigration application or petition before?

Have you ever been placed in removal, deportation, or exclusion proceedings?

Have you ever been detained by immigration authorities?

Do you currently have an immigration attorney or representative?

Have you ever been arrested?

Have you ever used name aliases?

Do you have any dependents (children or family members) currently in the United States?

Are any family members currently in immigration proceedings?

Consultation Preferences

Preferred Date *

Please select preferred date.

Preferred Time *

Please select preferred time.

Mode of Consultation *

Please select mode of consultation.

Attachments (Optional)

Upload relevant documents (Images, PDF, Word, Audio, Video - Max 10MB each)

Drag & drop files here or click to browse

Please review your information

Important Notice

NOTE: Our office is not liable to review, process, or cater to any information provided in this intake form until the $75 consultation fee has been received from the client.

Clients may submit payment via Zelle to: 281-229-8883.

If the client wishes to pay by card, payment can be made through PayPal:
Click here to pay via PayPal

Only after payment confirmation will the intake form be reviewed and the consultation scheduled.

Thank You!

Your consultation request has been submitted successfully.

Reference ID:

We have received your request and our legal team will review the information you provided. A qualified member of our team will contact you shortly to discuss your case and next steps. Please keep checking your email for updates or contact us at info@omarwelfareassociation.org

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