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an immigrant-led organization
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Deportation Defense Questionaire
← Back
Thank you for your response. ✨
Todays Date/ Fecha de Hoy
(required)
Full Name of Affected Person/ Nombre Completo de persona afectado
(required)
Age/ Edad
(required)
Date of Birth
(required)
Country of Origin/ Pais de Origen
(required)
Where is the person being held?/ ¿Adonde esta la persona detenida?
A# (If Applicable/ Si aplica)
Name of Person In charge of the defense process/ Nombre de persona en cargo del proceso de defensa
(required)
Relationship to person being detained/ Relacion con la persona detenida
Phone number (person in charge)/ Numero de telefono (persona engcargada)
(required)
Email
(required)
Physical address/ Direccion fisica
(required)
City/ Ciudad
(required)
Zip code/ Codigo Postal
(required)
Number of family members/ Numero de personas en la familia
Preferred Language/ Lenguaje que prefiere
(required)
Select an option
English
Español
Francais
Current immigration status/ Estatus Migratorio Actual
(required)
How was the person detained?/ ¿Como fue la persona Detenida?
Select an option
Detained by ice
Immigration check in
Traffic stop
Other
Do they have any type of immigration relief?/ ¿Tiene la persona algun tipo de alivio migratorio?
Work permit?/ ¿Permiso de trabajo?
How did the person enter the U.S.? / ¿Como entro la persona a los EEUU?
(required)
How long has the person lived in the U.S.?/ ¿Cuanto tiempo la persona ha vivido en los Estados Unidos?
Date of entry/ Fecha de entrada
Place of entry/ Lugar de entrada
Manner of entry/ Manera de Entrada
Has the person exited more than once and returned?/ ¿La persona a salido mas de una vez y regresado?
Select an option
Yes
No
Unknown
How many times?
Has the person been outside of the U.S. for for than 90 days?/ ¿La persona a estado fuera de los EEUU por mas de 90 dias?
Select an option
Yes
No
Date of last entry/ Fecha de Ultima entrada
Manner of last entry/ Manera de ultima entrada
Other entries en exits/ Otras entradas o salidas
In what manner have you exited the country? (deported/voluntarily etc.)/ ¿En que manera a salido del pais? (deportado/ salida voluntaria/ etc)
Have you ever had contact with immigration at the border?/ ¿Alguna vez a tenido contacto con inmigracion en la frontera?
Select an option
Yes
No
Maybe
Have you ever been detained by ICE at the border?/ ¿A sido detenido por ICE en la frotnera?
Select an option
Yes
No
Maybe
What date did ICE detain the person at the border?/ ¿En que fecha lo detuvo ICE en la frontera?
Have you ever been detained by ICE WITHIN the U.S.?/ ¿Alguna vez a sido detenido por ICE DENTRO de los EEUU?
Select an option
Si
No
Maybe
Date/ Fecha
Have you been previously deported?/ ¿A sido anteriormente deportado?
Select an option
Yes
No
Maybe
Do you have a future court date?/ ¿Tiene una cita en el futuro?
Select an option
Yes
No
Unknown
Have you ever missed a court date?
Select an option
Yes
No
Maybe
Has the person EVER been arrested?/ ¿AULGUNA VEZ a sido arestado?
(required)
Select an option
Yes
No
Maybe
Was the person arrested before 18?/ ¿Fue arestado antes de los 18?
Select an option
Yes
No
Has the person Ever spent more than 90 days in jail?/¿Alguna vez la persona a pasado mas de 90 dias en carcel?
(required)
Select an option
Yes
No
Have they ever been arrested in their home country?/ ¿Alguna vez a sido arrestado en su pais de origen?
(required)
Select an option
Yes
No
Reason/ Razon
Has the person received fines?/ ¿A recibido la persona multas??
Select an option
Yes
No
Unknown
Does the person have prior convictions that include: domestic violence, sexual abuse, theft, assault, pocesion of a firearm, drug traficking or DWI?/ Tiene antecedentes penales que incluyen: violencia domestica, abuso sexual, robo, asalto, posesión, o uso de arma de fuego, trafico de drogas, o DWI
Has anyone done an immigration petition?/ Alguna vez le han hecho una peticion de inmigracion?
(required)
Select an option
Yes
No
Don't know
Who petitioned for you?/ Quien lo pidio?
Was the petition made before April 30, 2001?/ La peticion fue antes del 30 Abril 2001?
(required)
Select an option
Yes
No
Don't Know
Immediate Family members who are U.S. Citizens?/ Familiares Inmediatos que son Ciudadanos de EU?
If kids are over 21 Yrs Old are they US Citizens?/ Si los Hijos son ciudadanos son mayores de 21 anos?
Do the kids have a grave medical condition?/ Tiene una condicion grave los hijos?
Select an option
Yes
No
Do you have a close family member who is a resident?/ Tiene algun familiar imediato con residencia permanente?
Select an option
Yes
No
Who?/ Quien?
Do you have a child or spouse who is an active member of the US armed forces?/ Tienes un hijo o conyuge en las fuerzas armadas activo?
Have you your parents children, siblings been a victim or a crime in the U.S.? / Alguna vez tu, tus padres, hijos hermanos han sido victima de algun crimen en los EU?
(required)
Select an option
Yes
No
Have you ever been a victim of domestic violence? / Alguna vez ha sido victima de violencia domestica?
Select an option
Yes
No
Who attacked you?/ Que persona la agredio?
Select an option
Resident
Citizen
Other
Have you ever collaborated with a law enforcement agency to resolve a crime?/ Alguna vez a colaborado con alguna autoridad policiaca para resolver un crimen?
Select an option
Yes
No
Before coming to the U.S. have you or a family member been persecuted, threatened or have been hurt by someone?/ Antes de llegar a los EU tu o tu familia fueron perseguidos, amenazados or lastimados por alguien?
(required)
Select an option
Yes
No
If applicable explain the above situation/ Si aplica explique la situación de la pregunta anterior.
Do you fear for your personal security if you had to return to your country of origin? / Teme por su seguridad si tuviera que volver a su pais de origen?
Select an option
Yes
No
Maybe
If applicable explain the above situation/ Si aplica explique la situación de la pregunta anterior.
Person who filled out the questionnaire/ Persona que lleno el cuestionario
(required)
Submit
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