AltoCalifornia Bus Ride for Justice
The Bus Ride will be taking place from June 23rd to July 3rd, 2013, starting in San Diego and ending in Sacramento. If eligible, once you complete the form, one of the ride organizers will contact you via phone. **Riders may be eligible for a stipend for participating in the ride, more information on thie TBA.
For more information about the bus route and activities schedules, contact
jonathan@theiyc.org
.
Personal Information
Información Personal
Full Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
E-mail
*
In what city do your currently live?
*
Where were you born?
*
Date of Birth
*
Please select a month
January
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Please select a day
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Please select a year
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Year
Upload Your Picture
*
Please tell us about your story (how/why you arrived to the United States, what do you do for a living, what are your goals, include background about your family, or not, if applicable, why do you want to participate in this campaign?).
*
Undocubus Participant Information
Información sobre participación en el camión.
Are you able to participate in an orientation for Riders on June 23rd in Los Angeles?
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Yes / Sí
No
As of now, what do you want your participation to be during the bus tour? [We understand this can change, but want to get an idea. Check all the necessary boxes].
*
I plan to be on the bus / Planeo estar en el camión
I plan to tell my story publicly / Planeo contar mi historia publicamente
I am willing to risk arrest during a civil disobedience / Estoy dispuesto/a a arriesgar ser arrestado durante una desobedencia civil
I am willing to risk being placed in deportation as a result of direct action or civil disobedience / Estoy dispuesto/a a arriesgar estar en proceso de deportación como consecuencia de una accion directa o desobedencia civil
Immigration History
Historia migratoria
When did you first enter the United States? [Month & Year]
*
How did you first enter the United States?
*
Entered with a visa (tourist, work, student) / Entre con visa (turista, trabajo, estudiante)
Entered by walking across the border / Cruce la frontera caminando
Other
If you entered with a visa, have you overstayed your visa?
*
Yes / Sí
No
I don't know / No se
Have you traveled outside of the United States (even for a short period of time) since you first entered?
*
Yes / Sí
No
I don't Know/ No se
If you have traveled outside the United States, please provide approximate date of departure, date of re-entry, and whether you entered with a visa any of these times.
Do you have an immigration attorney? If yes, name and contact information:
*
Family History
Historia familiar
Are either of your parents lawful permanent residents of the United States?
Yes / Sí
No
Are either of your parents citizens of the United States?
Yes / Sí
No
If you have children, are any of your children legal permanent residents?
Yes / Sí
No
If you have children, are any of your children United States citizens?
Yes / Sí
No
If any of your children are lawful permanent residents or United States citizens, please provide their ages:
Are either of your siblings lawful permanent residents of the United States?
Yes / Sí
No
Are either of your siblings United States citizens?
Yes / Sí
No
If any of your sibiings are lawful permanent residents or United States citizens, please provide their ages:
Are either of your aunts or uncles lawful permanent residents of the United States?
Yes / Sí
No
Are either of your aunts or uncles United States citizens?
Yes / Sí
No
Are either of your grandparents United States citizens?
Yes/ Sí
No
Are you gay, lesbian, bisexual, transgender or queer?
Yes / Sí
No
Do you have a boyfriend or a girlfriend?
Yes / Sí
No
Are you married?
Yes / Sí
No
Are you in a civil union?
Yes / Sí
No
Is your spouse, partner, or boyfriend/ girlfriend a lawful permanent resident?
Yes, U.S. citizen / Si, ciudadano de EE.UU
Yes, U.S. permanent resident/ Si, residente de EE.UU.
No
Education & Career
Educación y carrera profesional
Did you graduate from high school in the United States?
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Yes / Sí
No
I am currently in high school / Estoy en la preparatoria
If you did not graduate from high school, did you obtain your GED?
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Yes / Sí
No
I am currently finishing by GED / Estoy terminando mi GED
Have you attended college in the U.S.?
*
I am currently in college / Estoy en la universidad
I graduated from college / Ya me gradue de la universidad
No
Contact with Law Enforcement or Immigration
Contacto con las autoridades o inmigración
Have you ever been detained or processed by immigration officials? This includes when you first crossed the border, even if you were young when it happened.
*
Yes / Sí
No
Are you currently in deportation or removal proceedings?
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Yes / Sí
No
Have you ever been in deportation or removal proceedings?
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Yes / Sí
No
If you are currently in removal proceedings, please provide your Alien registration number (A#)
If you have been detained by immigration before, please check the box that applies to you:
*
They took my fingerprints/ Me tomaron las huellas digitales
I was deported/ Me deportaron
I was placed in removal proceedings/ Me pusieron en proceso de deportacion
I agreed to voluntary departure, and left the U.S. / Acorde salir del pais de manera voluntaria, y sali del pais
I agreed to voluntary departure, and stayed in the country / corde salir del pais de manera voluntaria, pero decidi quedarme
I have never been detained by immigration / Nunca eh tenido contacto con agentes de inmigracion
Other
Have you ever been arrested?
*
Yes / Sí
No
If you have been arrested in the past, were you convicted?
Yes / Sí
No
If you answered "yes," please describe what happened, and what were the charges.
If you have been arrested or convicted more than once, please list approximate date and charges:
Past Immigration Petitions
Solicitudes Anteriores de Inmigración
Please check the box if it applies to you:
A relative or employer has filed a petition to adjust my status, or that of my parents / Un pariente o empleador a sometido una aplicación para cambiar mi estatus migratorio, o el de mis padres
The petition was filed before May 1, 2001 / La petición fué sometida antes de Mayo 1, 2001
The petition was accepted by USCIS / La peticion fue aceptada por USCIS
The petition was rejected by USCIS / La peticion NO fue aceptada por USCIS
No one has filed a petition on my behalf / Nadie a sometido una petición de mi parte
Miscellaneous Questions
Preguntas Misceláneas
Please check the box that applies to you:
I have been a victim of a serious crime in the U.S., which I reported to the police. *Examples of serious crimes include domestic violence, robbery, physical attack, etc. / Yo eh sido victima de un delito grave en EE.UU. que reporte a la policía? * Ejemplos de delitos graves incluye violencia domestica, asalto, ataques físicos, etc.
My parents have been victims of serious crimes in the U.S. which they reported to the police. / Uno de mis padres a sido victima de un delito grave en EE.UU. que reporto a la policía
My siblings have been victims of serious crimes in the U.S. which they reported to the police. / Uno de mis herman@s a sido victima de un delito grave en EE.UU. que reporto a la policía
I have been in foster care / Yo eh estado en colocación familiar ("foster care")
I am afraid of returning to my home country / Tengo miedo de regresar a mi pais de nacimiento.
If you, either of your parents, or your siblings have ever been a victim of a serious crime, and/ or you are afraid of returning to your home country, please elaborate.
Thank you for providing this information. As mentioned, an attorney and an oganizer will be looking at your case and assessing the risk of your participation. This intake is based on the Educators for Fair Consideration and the Education Not Deportation/ National Immigrant Youth Alliance Legal intake form for people in removal proceedings.
Gracias por proveer esta información. Como mencionamos, un abogado y un organizador comunitario vera tu caso y asesorando los riesgos de tu participación. Este formulario esta basado en el formulario legal de Educators for Fair Consideration y Education Not Deportation/ National Immigrant Youth Alliance para gente en proceso de remoción.
SUBMIT YOUR INFORMATION
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