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Legal Staff Inquiry Form











Inquiry Responder*:
First Name:
Last Name:
Date (MM/DD/YY):

(leave blank for today)
Current City:
Current State:
Current Zip:
Current Country:
Country of Origin:
Inquiry Source*:
Inquiry on behalf of:
Inquirer: (if not “Myself”)
Gender:
Trans Designation:
Sexual Orientation:
HIV Status:
Detained?
Binational Couple?
Children?
Household combined annual income is below $31,000.
Intake Scheduled:
Sent Expert List:
Gave Lawyer Referral:
Sent Country Conditions Info:
Description*: