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Check List _____ Identification Document/s (Matricula, Passport, School , College, or University ID, Texas DPS ID, Drivers

License, other form of government issued ID with photo) ____ Acta/s (Birth Certificate, Marriage Certificate/s, Divorce Decree/s) We will use one immediately. You have time to order one or two extra for later uses) ____ Filled out Office Intake Form ____ School Records for each year in school, if graduated, your high school diploma, if not, your GED, if not in school, have no diploma and no GED, then record that you are enrolled in GED classes, if you are in college, university or have ever attended either, the record for each year in attendance, record of any training that you are involved in or have been involved in. ____ Other records. Other records are needed to cover time after you left school through graduation or drop out, like employment letters, pay stubs, employment records from your employers, income tax reports, if any. ____ Other records that would help are records that cover your time after graduating from high school, records that are in your name or that has your name on them, like apartment leases, utility bills, cellular phone bills, medical bills, vacuna records, bank records, credit card records, purchase records, installment purchase records, month by month, if the bill or statement is month by month. ____ 2 color photographs, 2 inches by 2 inches, passport type. ____ Criminal background check letter or statement from the district clerks office for the last 10 years if you are under 25 years of age and 20 years if you are over 25 years of age. ____ Government fee of $465.00. ____ Attorney fee of $300.00 ____ Make Appointment

Intake Form from the Office of Ennio Diaz for Proposed Deferred Action Policy Name (As Listed on Birth Certificate)
Last (Paternal) ___________________ First___________________ Middle_________________ Last (Maternal)______________________________ Address_______________________________________________________________________ City:__________________________ State________________ ZIP_________________________ Home Phone___________________ Cel Phone______________Work Phone_______________ Date of Birth: _______________Place of Birth:________________________________________ (mm/dd/yyy) City State Country (Mark with X) Gender: Male ______Female ______

Marrital Status
(Mark with X) ______ ______ ______ ______ Married Widowed Single Divorced

Date of Entry and Place of Entry in the United States


Date of Entry_______________ Place of Entry (US) ____________________________________ City State

Residence (from the day you entered the Inited States to present, starting with present)
Address City State ZIP From To

______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________

______________________________________________________________________________

Education
Current Education Status: ___ ___ ___ ___ I am a student in the ______ in school (if you have not graduated yet) I graduated from high school and have a high school diploma I did not graduate from high school, but finished my GED and have a GED certificate I did not graduate from high school, but am currently enrolled in a GED program

Name, city and state of school currently attending or where high school diploma was received or where GED certificate was received ______________________________________________________________________________ Name City State Date of graduation or date you received your GED ____________________________________ Month Day Year

Trips Abroad Since Your First Entry Into the US


From the Date of Your First Entry in the United States, List Number of Times You Have Returned to Your Country of Origin City From To mm/yy mm/yy ______________________________________________________________________________ ______________________________________________________________________________ Have You Ever been issued a Social Security Document? (Mark with X) ___Yes ___No If yes, List the Number_________________ Province Country

Have You Ever Been Assigned a Registration Number by Immigration? (Mark with X) ___Yes ___No If yes, List the Number_________________

Have You Ever been in any kind of proceeding before the United states immigration Service? (Mark with X) ___Yes ___No Date _______ Outcome________________

If yes, Provide Place: ______________________

______________________________________________________________________________ ______________________________________________________________________________

Income Information
My current annual income is:_________________________ My current annual expenses are______________________ The current value of my assets are:____________________

Criminal Background
Have you ever been charged with a crime? ______ Yes ____ No

If Yes read on and respond to the questions below. This part of the intake form seeks to find out if you have a criminal background. The government is interested in any criminal history that involves felony convictions and misdemeanor convictions. Normal traffic tickets are not regarded as significant, thus do not have to be listed. Any traffic situation that involves hit and run, eluding the police in a traffic stop, failure to stop and render aid and provide information at the scene of an accident is more than a normal traffic ticket and should be listed. What the government asks for is noted below and you are requested to provide the information requested to the best of your ability. If you should have any questions, feel free to call our office to clarify any question that you might have. If you have ever been arrested for a DWI or DUI, please include that information below under misdemeanor. If you have a criminal record, misdemeanor or felony, we will be needing a copy of the record. Regardless, you will also be needing a copy of a criminal record check from the county district clerk for the counties you have live in during the last 5 years. Call Bernardo Eureste with my office for information on where to obtain a criminal record search from the district clerk. Are individuals with a conviction for a felony offense, a significant misdemeanor offense, or multiple misdemeanors eligible for an exercise of prosecutorial discretion under this new process? No. Individuals who have been convicted of a felony offense, a significant misdemeanor offense, or three or more other misdemeanor offenses not occurring on the same date and not arising out of the same act, omission, or scheme of misconduct are not eligible to be considered for deferred action under the new process. What offenses qualify as a felony? A felony is a federal, state, or local criminal offense punishable by imprisonment for a term exceeding one year. What offenses qualify as a significant misdemeanor? A significant misdemeanor is a federal, state, or local criminal offense punishable by no more than one year of imprisonment or even no imprisonment that involves: violence, threats, or assault, including domestic violence; sexual abuse or exploitation; burglary, larceny, or fraud; driving under the influence of alcohol or drugs; obstruction of justice or bribery; unlawful flight from arrest, prosecution, or the scene of an accident; unlawful possession or use of a firearm; drug distribution or trafficking; or unlawful possession of drugs. How many non-significant misdemeanors constitute multiple misdemeanors making an individual ineligible for an exercise of prosecutorial discretion under this new process? An individual who is not convicted of a significant misdemeanor but is convicted of three or more other misdemeanors not occurring on the same day and not arising out of the same act,

omission, or scheme of misconduct is not eligible to be considered for deferred action under this new process. (Mark with X) Felony Conviction ____ Yes ____No

If yes, provide the name of the offense______________________________________________ Date:_____________________ Penalty: Fine:___________________ Jail Time:____________________________ Place (City/State)__________________________ Prison Time: ____________________________ (Mark with X) Felony Conviction Place (City/State)______________________ County/State_____________________________________

____ Yes

____No

If yes, provide the name of the offense______________________________________________ Date:_____________________ Penalty: Fine:___________________ Jail Time:____________________________ Place (City/State)__________________________ Prison Time: ____________________________ Misdemeanor Conviction ____ Yes Place (City/State)______________________ County/State_____________________________________

____No

If yes, provide the name of the offense______________________________________________ Date:_____________________ Penalty: Fine:___________________ Jail Time:____________________________ Place (City/State)__________________________ (Mark with X) Misdemeanor Conviction County/State_____________________________________

____ Yes

____No

If yes, provide the name of the offense______________________________________________

Date:_____________________ Penalty: Fine:___________________

County/State_____________________________________

Jail Time:____________________________ Place (City/State)__________________________ (Mark with X) Misdemeanor Conviction

____ Yes

____No

If yes, provide the name of the offense______________________________________________ Date:_____________________ Penalty: Fine:___________________ Jail Time:____________________________ Place (City/State)__________________________ County/State_____________________________________

Ennio Diaz Attorney at Law 5615 Richmond Avenue, Suite 250 Houston, Texas 77057 713-581-7051 This letter represents a request for an employment status letter. The person making a request for a letter of employment is applying for legal status to be granted under the Deferred Action Program announced by President Barack Obama on June 15, 2012. If you can prepare the letter requested, please understand that the original letter is what will be used as a part of the immigration application. As such, we ask that you provide the original to the requesting party or mail the letter to us at the address above. The letter should be on company letterhead, Below is an example of the type of letter we need: Date TO WHOM IT MAY CONCERN: This letter certifies that [name of worker] is an employee of this company. [name of worker] has worked with this company from 00-00-00 to the present. D u r i n g t h e t i m e t h a t [ n a m e o f work er] was em plo yed at t his com pan y, he/she resided a t [street address, c i t y , s t a t e , z i p ] . [name of worker] position is that of a full- time [specify position] working [number of hours or days per week] at the rate of [$00.00 per hour/week]. [name of worker]s projected annual income for the current year is [$00,000.00].

Respectfully, Signature Print Name of Person Providing Information Print Title of Person Providing Information Call me at 832-788-9671 if you need any further information

on how to prepare this

letter.

Ennio Diaz Attorney at Law 5615 Richmond Avenue, Suite 250 Houston, Texas 77057 713-581-7051 This letter represents a request for an employment status letter. The person making a request for a letter of employment is applying for legal status to be granted under the Deferred Action Program announced by President Barack Obama on June 15, 2012. If you can prepare the letter requested, please understand that the original letter is what will be used as a part of the immigration application. As such, we ask that you provide the original to the requesting party or mail the letter to us at the address above. The letter should be on company letterhead, Below is an example of the type of letter we need: Date TO WHOM IT MAY CONCERN: This letter certifies that [name of worker] is an employee of this company. [name of worker] has worked with this company from 00-00-00 to the present. D u r i n g t h e t i m e t h a t [ n a m e o f work er] was em plo yed at t his com pan y, he/she resided a t [street address, c i t y , s t a t e , z i p ] . [name of worker] position is that of a full- time [specify position] working [number of hours or days per week] at the rate of [$00.00 per hour/week]. [name of worker]s projected annual income for the current year is [$00,000.00].

Respectfully, Signature Print Name of Person Providing Information Print Title of Person Providing Information Call me at 832-788-9671 if you need any further information

on how to prepare this

letter.

Ennio Diaz Attorney at Law 5615 Richmond Avenue, Suite 250 Houston, Texas 77057 713-581-7051 This letter represents a request for an employment status letter. The person making a request for a letter of employment is applying for legal status to be granted under the Deferred Action Program announced by President Barack Obama on June 15, 2012. If you can prepare the letter requested, please understand that the original letter is what will be used as a part of the immigration application. As such, we ask that you provide the original to the requesting party or mail the letter to us at the address above. The letter should be on company letterhead, Below is an example of the type of letter we need: Date TO WHOM IT MAY CONCERN: This letter certifies that [name of worker] is an employee of this company. [name of worker] has worked with this company from 00-00-00 to the present. D u r i n g t h e t i m e t h a t [ n a m e o f work er] was em plo yed at t his com pan y, he/she resided a t [street address, c i t y , s t a t e , z i p ] . [name of worker] position is that of a full- time [specify position] working [number of hours or days per week] at the rate of [$00.00 per hour/week]. [name of worker]s projected annual income for the current year is [$00,000.00].

Respectfully, Signature Print Name of Person Providing Information Print Title of Person Providing Information Call me at 832-788-9671 if you need any further information

on how to prepare this

letter.

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