
Name: First Last:
Spouse Name: First Last
Marital Status:	Married Single Divorced
If married, how many years?:
Address:
City, State, Zip
Home Phone:
Mobile Phone:
Spouse Mobile Phone:
Do you have a completed International Homestudy?:	Yes No If YES, Date of completion:
Have you filed the I600A or I800A with USCIS?	Yes No If YES, Date of completion:
How would you like to receive our information?	Postal Mail Email Email Address: