A_______-_______-_______

Before:_____________ Immigration Judge Date: _______-_______-_______

Language: English Spanish ________________ Interpreter: _____________________

 

DHS Atty: _______________ R. Counsel: _____________________

Pro se

 

Initial Bond: $______________; No Bond

Age: _______ Marital Status: Single Common law relationship

Legal Marriage Separated/Divorced

 

Family Ties & Family Immigration Status:

Spouse Mother Brother(s)

______Child(ren) Father Sister(s)

Aunts, Uncles, Cousins ___________________ ___________________

 

Immigration History:

Entered: ______________ Status: _____________________________________________________

______________________________________________________________________________________

 

Criminal Record:

___-___-___ : ___________________________ - sentenced __________; served __________ (Admit/Deny)

___-___-___ : ___________________________ - sentenced __________; served __________ (Admit/Deny)

___-___-___ : ___________________________ - sentenced __________; served __________ (Admit/Deny)

___-___-___ : ___________________________ - sentenced __________; served __________ (Admit/Deny)

______________________________________________________________________________________

______________________________________________________________________________________

Prison ? INS; Release date: ____________________

 

Education & Employment History:

______________________________ ( ) _____________________________ ( ) ______________________________ ( ) _____________________________ ( )

 

Will reside: w/ _____ at __________________________________________________________________

DHS Requests: $__________________; No Bond R. Requests: $____________________

Relief: COR/LPR COR/NLPR Pre-VR Post VR

Asylum Withholding Torture 209

Registry Adjustment Termination 212(c)/_______

Bond Decision: No Bond (Mandatory/Danger/Flight) O.R. $__________ & _________

Appeal: Waived by Both Reserved by A/I/B Due: ______-______-______

Next Hearing: Master Calendar Group Hearing Individual Calendar Con’t. Bond

 

for _______-_______-_______ at ______:__________ a.m./p.m.