Immigration Referral Form for Foster Children

Referral Source:(Required)

Name of Organization:(Required)

If associated with an office or organization, please provide their name.

Contact Person Name:(Required)

First Last

Contact Person Phone:(Required)

Contact Person Email:(Required)

Immigration Assistance Being Requested

Child Under 21

Does this request for immigration assistance involve a child or young adult under the age of 21?

Yes

Active Child Welfare Case

Does this request for immigration assistance involve a child or young adult with an active child welfare case?

Yes

While all referrals will be reviewed, Child Advocates legal team cannot accept cases unless the child is involved with the child welfare system.

County of Child Welfare Case:

DCS Family Case Manager Name:

First Last

Child's Legal Name:

First Last

Preferred / Chosen Name

Pronouns

Child's Age:

Child's Preferred Language:

CHINS Cause Number:

(if known)

Pending Immigration Court Date or Removal:

Immigration Status:

(select one)

Summary of Immigration Need/Request:

This information is being provided only for the purpose of determining the ability of Child Advocates’ legal team to assist the youth with immigration matters. Information provided will be kept confidential and not disclosed beyond the purposes of this referral. Once a case is accepted, additional identifying information will be requested.

Upload your birth certificate:

Accepted file types: jpg, png, pdf, Max. file size: 300 MB.

Upload identification documents:

Accepted file types: jpg, png, pdf, Max. file size: 300 MB.

Upload immigration documents:

Accepted file types: jpg, png, pdf, Max. file size: 300 MB.

Name

This field is for validation purposes and should be left unchanged.

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