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Appellate Referral Form
Intake Received Via
Case Type
Assigned
Your First Name
Your Last Name*
Your Email
Your Phone
Client First Name (if not contact)
Client Last Name (if not contact)
Client Date of Birth (ILS)
Client Country of Birth (ILS)
Alien Number
Client Manner of Initial Entry (ILS)
Manner of Entry (if Other)
Client Date of Initial Entry (ILS)
Client Current Immigration Status (ILS)
Current Immigration Status (if Other)
Date Received Current Immigration Status
Client Detention
Custody Location
Court & Conviction History
Upload a File

File(s) size limit is 20MB.

Attach the court file and minutes, and a FOIA response from Homeland Security if available. Please label each file with the client’s first and last name, eg (LAST, First – file name)
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