Crisis Help Request Form Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Full Name of Person in Crisis *FirstLastDate of Birth *Contact Information *Country of Origin *Crisis Type *Deportation riskAsylum case delayPolitical prisoner in dangerOtherIs this a deportation, asylum, or human rights crisis?Why is this urgent? *Explain the risk of harm, deadlines, etc.Additional DetailsProvide any other relevant information.Other Crisis DetailsIf ‘Other’ was selected, please describe the crisis.Is there an upcoming deadline? If yes, please put the date below.DateTimeCurrent LocationAddress Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeLegal StatusGreen cardAsylum seekerRefugeeUndocumentedHas a Lawyer been assigned?YesNoIf yes, lawyer's name & contact infoHas any government agency been involved? (ICE, USCIS, etc.)Upload Documents (Court orders, letters from employers, witness statements, etc.) Click or drag a file to this area to upload. Are there any human rights organizations already assisting? YesNoContact Person Information (If Different from Person in Crisis) *FirstLastContact person's phone numberContact Person's Email *Relationship to person in crisisI consent to sharing this information with Voice of Iran WA for assistance.Yes Origin of a I understand this does not guarantee legal representation but helps connect me with resources.YesSubmit Request
