Destination USA Consulting Preliminary Questionnaire

Personal Information

Title: Mr.Ms.Mrs.



Date of Birth:
Date of Birth(Spouse):
Country of Birth:
Country of Birth(Spouse):
Marital Status:
If Divorced, what is the date that the divorced was finalized?
Please list all children (if any):
If you have any dependent children not immigrating with you, please explain:
What is your purpose in coming to the U.S.? (i.e. Education, Employment, Reuniting with Family, etc.)
Do you or spouse currently have any relatives who are a citizen or permanent resident living in the U.S.? yesno
If yes, please explain their relationship (ie Aunt, Uncle etc.) and their status in the U.S. (i.e. Citizen, Permanent Resident):

Education and Work History

What is your highest level of Education? (Select completed degree only):
If Other:
If you or your spouse/partner graduated from a four year institution or higher, please list any majors or degrees that you or your spouse/partner has obtained :
How many years of full time professional experience do you have?
Your Current Occupation:
Start Date:
What is your level of the English Language?


Language Training

Are you or your spouse interested in one-on-one English tutoring? YesNo
Are you or your spouse interested in group lessons for learning English? YesNo
Do you or your spouse need help in preparing for TOEFL? YesNo
Please list anyone else besides you or your spouse who may be interested in the above services:

Traveling and Shipping

Do you need help in planning and making arrangements for you and your family for travel to and from the U.S.? YesNo
Do you require any international shipments of personal items to the U.S. from your country of origin? YesNo
Do you have any pets that need relocating? YesNo


Do you need assistance with IRS registration? YesNo
Do you need assistance with filing taxes? YesNo


Do you need assistance with Apartment/Housing search? Lease negotiations? YesNo
Do you need assistance with purchasing a home? YesNo

Employment and Career

Do you require assistance with finding a career here in the U.S.? YesNo

Children Education and Care

Do you have any children that require attendance at a child care center? Pre-school? K-12? YesNo

Health and Fitness

Do you require assistance with Health Care Insurance? YesNo
Do you require assistance with finding doctors or health care facilities? YesNo
Are you interested in athletic opportunities for leisure for your family? YesNo


Do you require assistance for immigration related matters? (i.e. interviews, paperwork, translation of immigration documents) YesNo


Do you need assistance with the driver’s license application process? YesNo
Do you require a personal driver? YesNo


Have you or your spouse managed/owned a business? If yes, Please provide a description of your business experience (past and present), occupation title, responsibilities at the job and the number of years of experience:
Are you interested in starting your own company here in the U.S.? YesNo


Please include any additional information that you would like us to know:


I, the undersigned, hereby certify that the information on this form is true and correct and can provide proof upon request. I further declare that I fully understand the contents of this form and previously mentioned conditions. I waive Destination USA Consulting and its subsidiaries of all present and future liability on evaluations provided by them. I understand that the assessment will be provided based on the information I have provided in this form.

By clicking Send you are electronically signing this.