Client Intake Form

To make an appointment at our upcoming clinic, complete the intake form and the Washington New Americans staff will get back to you to confirm your registration. Please fill this form out as completely as possible. For any items that do not apply to you, please type “N/A” into the field.

If your appointment is confirmed, WNA will print this form and have it available at our workshop for your appointment.

Client Intake Form (Multi-Page)
  • General Info
  • Addresses
  • Work
  • School
  • Children
  • Marriages
    • Trips
    Name
    Name
    First Name
    Last Name
    See date on “green card”
    Male, Female or Other
    $
    Including yourself and those who live separately if they appear on your taxes
    Do you receive public benefits?
    How did you hear about this workshop?
    Do you want to receive information about volunteer opportunities?