Immigration justice clinic screening pace university school of law



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JOHN JAY LEGAL SERVICES, INC.

IMMIGRATION JUSTICE CLINIC SCREENING

PACE UNIVERSITY SCHOOL OF LAW


Date of Inquiry:
Type of Inquiry:

Call Letter e-mail walk-in

Staff Completing Inquiry Record:


Name of Inquirer:
Telephone # / email of Inquirer:
Relationship to person needing assistance:

Self Family Friend  Professional

(If family, note specific relationship, e.g. “mother”)

If Inquirer is spouse/parent/adult child of person needing assistance, is Inquirer USC or LPR?

Referred to JJLS by (agency/attorney/website):

Person in need of assistance

Name:
Language(s) spoken: Age:


Country(ies) of origin/citizenship/nationality:


Year of most recent entry to U.S.:

entry with visa/EWI?

if visa, type of visa?
Current immigration status:
Is a court hearing or agency appointment scheduled?

 Yes  No
If yes, date _______________ and time _________
Name and address of Agency/Court where appointment/hearing is scheduled:


A” # of person in need of assistance

(this ID # appears in any letters/documents received from immigration after a person is processed, or when a notice (“NTA”) for a hearing date is provided):
Person in need of assistance

Home Address:
Home Telephone:
Cell phone:
Email:

Type of Legal Assistance Needed:

Have any attorneys been previously consulted/hired about this problem?

Name of and other information about prior attorney:

When, or at what stage of process?

Private, pro bono, or non-profit legal service provider?

If paid, how much paid?

Is any attorney/legal representative currently assisting or providing representation?

Name of and other information about current attorney:

How much, if anything, could you afford to pay for:

1) an initial consultation with an attorney?

2) full representation (may affect referral to other sources

of representation if we cannot offer assistance)?

Current employment?

 Full-time  Part-time: hours worked/week

Other significant sources of income?

Person in need of assistance

Highest level of education completed:

Currently enrolled in school or educational program?

If yes, describe:


Ever been detained by any law enforcement authority?

 Yes  No
When:
Where:
Immigration Detention?  Yes  No
Where?
Currently Serving Time for Crime?

 Yes  No Where?
DIN#:
Crime:
Date and Place of Conviction:
Sentence imposed:


Information Provided to Inquirer

 Cannot provide additional information/response

 Request additional information and if received,

will proceed further

 Will contact after review with supervisor

 List referrals provided:

Follow-up/Review by:

Date Inquiry Closed/Opened:

Assigned to:



ADDITIONAL INFORMATION ABOUT CALLER’S IMMIGRATION ISSUES



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J:\IJC\INQUIRIES\IJC BRIEF INTAKE (2015)




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