Request for Assistance with Responding to Notice of Intent to Terminate (NOIT)

First Name

Last Name

Birthdate

Alien Number (A#):

If the A# is under 9 digits, include a 0 at the start

Phone 1

Country of origin

Country of residence

Nationality

Language preference:

Other languages spoken

Date of arrival in the U.S.

Date of adjustment of status filing:

Date on NOIT:

Has the refugee already submitted a response to the NOIT requesting more time to respond and an opportunity to provide oral testimony?

YesNo

Has the individual already filed a FOIA request for their refugee case file?

YesNo

If a FOIA request has already been submitted, have the results been received? If yes, please upload with this form if available.

YesNo

Referring Organization

Other Referring Organization:

Referrer Name:

Referrer Contact Info:

(email and/or phone)

Does the refugee consent to sharing information with pro bono attorneys to try to find representation?

YesNo

Can IRAP share the referrer information with any pro bono in case they need help connecting with client or obtaining signed G28?

YesNo

Upload file: [NOIT, FOIA etc]