USCRI - Protecting Refugees, Serving Immigrants, and Upholding Freedom Since 1911: Survey - Immigrant Children's Legal Program Referral Form

Immigrant Children's Legal Program Referral Form

Welcome to the confidential online referral system of USCRI's Immigrant Children's Legal Program (ICLP), formerly the National Center for Refugee & Immigrant Children. ICLP helps unaccompanied immigrant children obtain pro bono attorneys.

Please provide the following information so that we can assist the child in need of services. The information provided is confidential and will only be shared for the purpose of obtaining legal counsel. ICLP cannot assist children outside the U.S.

Question - Not Required - Name of person referring the case:

Question - Not Required - Title:

Question - Not Required - Agency:

Question - Not Required - Address:

Question - Not Required - City:

Question - Not Required - State:

Question - Not Required - Zip:

Question - Not Required - Tel.:

Question - Not Required - Fax

Question - Not Required - Email:

Question - Not Required - Do you currently represent this child?

Question - Not Required - Have you filed a G-28?

Question - Not Required - Have you filed an EOIR-28?

CHILD'S CONTACT INFORMATION:

Question - Not Required - Child's First Name:

Question - Not Required - Child's Last Name:

Question - Not Required - Child's Alien Number:

Question - Not Required - Child's Date of Birth:

Month

Day

Year

Question - Not Required - Child's Gender:

Question - Not Required - Country of origin?

Question - Not Required - Language(s) the child can communicate in:

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - Where does the child live? ORR Facility
ORR Foster care
Family
Other

Question - Not Required - Address:

Question - Not Required - City:

Question - Not Required - State:

Question - Not Required - Zip:

Question - Not Required - If detained, expected release date:

Month

Day

Year

Question - Not Required - Is the child currently living with his/her mother and/or father? Yes
No

CAREGIVER'S CONTACT INFORMATION:

Question - Not Required - First Name:

Question - Not Required - Last Name:

Question - Not Required - Tel.:

Question - Not Required - Cell:

Question - Not Required - Email:

Question - Not Required - Brief description of case:

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - Special circumstances (e.g., disability, safety, mental health):

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - Possible forms of immigration relief currently identified:

	Asylum
	SIJS
	Trafficking
	Other:

Question - Not Required - Other:

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - Change of Venue Status, filed by whom:

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - Next hearing date:

Month

Day

Year

Question - Not Required - Immigration Judge:

Question - Not Required - Immigration Court Location:

Question - Not Required - Status of Case:

Question - Not Required - Other:

(Maximum response 255 chars, approx. 5 rows of text)

The Immigrant Children's Legal Program (ICLP) does not provide direct representation or legal advice. ICLP serves as a referral source matching pro bono attorneys with unaccompanied immigrant children released from federal custody in the United States.

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