SHC Legal

Your name*

Given nameFamily name
What languages do you speak?*

EnglishSpanishOther language
Enter your phone number carefully. If your phone number is incorrect, we cannot process your application.
Do you have a U.S. mobile phone number?*

YesNo
Enter your U.S. mobile phone number beginning with the area code.*
Please enter a valid phone number.
Enter your mobile phone number beginning with the country code.*
Please enter a valid phone number.
Please enter your email address if you have one. If you include a valid email address you will receive a confirmation by email of your submission within a few minutes.
example@example.com
Thank you for providing an email address. For confirmation, please re-enter your email address.
example@example.com
The email addresses that you entered do not match. Please correct this problem before you continue.
Your Current Address*
Street address
Apartment or unit number
City*
State*
Zipcode*
Date of birth*

DayMonthYear
Enter the day first, the month second, and the year last
Country where you were born*
Enter the "A" number assigned by immigration officials. If you have a green card or a work permit it is written on your card. This number is written on most immigration notices or letters that have been provided to you. Sometimes it is called a Case Number or a File Number. If you leave this field blank, the processing of your application may be delayed. If you cannot find this number, ask a friend or relative to help you find it.
Please provide any additional information that will help us understand what you need.
OPTIONAL PHOTOS

Please send us photos of the following documents if you have them. The photos will help us process your request more quickly. We will not share your photos with anyone outside the Immigration Legal Services Program without your consent.
- Permanent resident card (green card)
- Work permit card
- Driver's license
- National ID card from your home country
- Passport identification page with your photo
- Notices from USCIS (I-797C, for example)
- Hearing notices for immigration court
- Notice to Appear
You can add one or more photos by tapping below.

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1) I understand that the Sacred Heart Center has not agreed to serve as my attorney or accredited representative in my case.*

YesNo
2) I understand that this form is an application to request assistance from the Immigration Legal Services Program at the Sacred Heart Center.*

YesNo
3) We will let you know as soon as possible when and if we can help you. If we cannot help you we will send you list of law firms that you can call for assistance. Do you understand?*

YesNo
To complete your application for assistance with immigration, you must confirm that you understand each of the three statements above.
Type your name below as your electronic signature and tap on the green button below to submit your application to the Immigration Legal Services Program at the Sacred Heart Center. We cannot process applications that are not electronically signed.*
Sign your name by typing your name here.
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Immigration Legal Services Program Sacred Heart Center