Asylum and Refugee Assistance Form

First name

Middle Name

Last name

A Number

Did you already win your Asylum case?

Yes

No

What is your address?

Multi-line address

Country/Region

Address

City

Zip / Postal code

Phone Number

By checking this box, I confirm that I have been granted asylum in the United States based on a religious claim.

I authorize the Religious Freedom Center to verify my asylum status and the basis of my claim.

I authorize an attorney affiliated with or representing the Religious Freedom Center to request my hearing transcript and any related records on my behalf to verify my asylum case.

Signature

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