I-589 Intake Form

Application for Asylum and Withholding of Removal

Please complete this intake form to help us prepare your I-589 asylum application. All information is strictly confidential and protected by attorney-client privilege.

IMPORTANT: Asylum cases have strict filing deadlines.

You generally must file within 1 year of your arrival in the U.S. Contact us immediately for a consultation.

Full Legal Name (as shown on passport) *

Other Names Used (maiden name, aliases, etc.)

Date of Birth *

City/Town of Birth

Country of Birth *

Present Nationality/Citizenship

Gender

Marital Status

A-Number (if any)

Social Security Number (if any)

Current Address in the United States

Street Address

Apt/Unit #

City

State

Zip Code

Phone Number *

Email Address *

Immigration Information

Date of Last Arrival in the U.S.

I-94 Number (if any)

Immigration Status at Last Arrival (e.g., B-1, B-2, F-1, EWI)

Current Immigration Status

Status Expiration Date (if applicable)

Passport/Travel Document Number

Country That Issued Passport

Passport Expiration Date

Have you ever been in immigration court proceedings?

Yes

Have you previously applied for asylum in the U.S.?

Yes

Upload supporting documents for your asylum application. Accepted formats: PDF, JPG, PNG (max 10MB each).

Recommended documents: Passport, I-94, birth certificate, police reports, medical records, country condition evidence, photographs, affidavits, news articles, identity documents.

or drag and drop files here

Maximum file size: 10MB

Or email documents to [email protected]

I certify that the information provided is true and correct to the best of my knowledge. I understand that providing false information may result in denial of my application and possible legal consequences. I understand that this intake form does not constitute an attorney-client relationship until a retainer agreement is signed.

I agree to the above certification *

Chat on WhatsApp