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Asylum Form



Name:
Address:
City:

State:

Zip Code:
Phone:
Work Phone:

Email:
Nationality:

Age:

Birth Date:
How did you hear about us?

When did you enter the U.S.?:
With what kind of visa, if any, did you enter the U.S.? :
Has your authorization in the U.S. expired?If yes, when?
Have you already applied for asylum at the asylum office?
Are you currently in deportation/removal proceedings?
What country are you from?

Do you fear returning to your country?
Please provide a detailed description of your case below:

Have you ever been convicted of a misdameanor or a felony?
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