Immigration Waiver Case Summary Form
Please complete this form to provide a structured summary of your immigration waiver case. All fields are required for a complete case overview.
Applicant Full Name
*
First Name
Last Name
Applicant Email Address
*
example@example.com
Applicant Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Country of Origin
*
Please Select
Mexico
India
China
Philippines
Nigeria
Other
Type of Waiver Requested
*
Please Select
I-601 Waiver (Unlawful Presence)
I-601A Provisional Waiver
I-212 Waiver (Reentry after Removal)
Other
Primary Reason for Waiver
*
Please Select
Extreme Hardship
Family Unity
Medical Necessity
Other
Summary of Case Circumstances
*
Date of Submission
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Attorney or Representative Name
*
First Name
Last Name
Current Case Status
*
Please Select
Draft/Not Submitted
Submitted
In Review
Approved
Denied
Other
Submit Case Summary
Should be Empty: