Hotline Caller Data Entry Form (Full) Step 1 of 6 16% Phone(Required)Email Address(Required) ZIP Code Calling For(Required)ChooseSelfFamily MemberFriendDetained?(Required)ChooseYesNoNot sureCountry of Origin(Required)ChooseAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÃ…land IslandsPreferred Language(Required)ChooseSpanishEnglishArabicChineseDariFrenchGujaratiHindiKoreanPashtoPersianRussianTagalogUkrainianUrduVietnameseAmerican Sign LanguageAgreed to receive text messages?(Required) Yes No How did caller find out about the hotline?(Required) Word of mouth Received Hotline info card/given Hotline number by another legal service provider Received Hotline info card/given Hotline number by social services provider Citizenship PSA HILSC Website Detained relative/friend Other If other was chosen for "How did caller find out about hotline?" please describe.Do you have a lawyer working on your immigration case?(Required)ChooseYesNoNot sureType of Question(Required)ChooseImmigration relatedSocial Services RelatedCivil Legal Services Question (family law, real estate etc.)Criminal Legal Services QuestionQuestion topic(Required)ChooseImmigration courtImmigration Enforcement-DetentionAnti-Immigrant CallImmigration Enforcement-RaidCitizenshipNew Texas policies/lawsNew federal immigration policiesWhat is happening at the borderAsylumCrime victims (U visa)Trafficking (T visa)Unaccompanied childrenFamily visasGeneral immigration optionsDACAVAWASocial ServicesCivil Legal ServicesScreening needed?(Required)ChooseNone neededPathway Legal ScreeningCitizenship ScreeningDetained Screening Date Time Hours : Minutes AM PM AM/PM Where?Detained by? CBP FBI Sheriff Uknown ICE Other What happened before, during and after detention?Do they currently have immigration status?UndocumentedParoleTPSDACALPRNonimmigrant (visitor, employment, etc.)US CitizenHow long have they lived in the U.S. before being detained?Have they had a recent Immigration Court hearing?Do they have an A#?Do they have family that depend on them? Year received legal permanent residency(Required)What was basis for LPR(Required)Through marriage, still married to same personThrough marriage, NOT married to same personThrough other means (U visa, T visa, other family petitions besides spouse, employment based)Been outside US for more than 180 days(Required)NoYesLived in Texas more than 3 months(Required)YesNoEver been stopped by law enforcement(Required)YesNoEver been fingerprinted, except for immigration biometrics(Required)YesNo Citizenship Screening ResultsYou can give the caller the following information:Based on the answers above, it appears that you do not yet qualify for citizenship.Based on the answers above, it appears that you do not yet qualify for citizenship.Based on the answers above, it appears that you do not yet qualify for citizenship.Based on the answers above, it appears that you may have been outside the United States for more than 180 days. We would recommend that you speak with an attorney in a one-on-one consultation and do not go to a workshop to do your citizenship application.Based on the answers above, it appears that your citizenship application may be complicated by contact with law enforcement. We would recommend that you speak with an attorney in a one-on-one consultation and do not go to a workshop to do your citizenship application.Based on your answers to the questions it appears that you may be eligible to apply for citizenship. We can help you schedule a slot at a workshop or give you the contact information for a one-on-one consultation. https://houston.naturalizenow.org/ Based on your answers to the questions it appears that you may be eligible to apply for citizenship. We can help you schedule a slot at a workshop or give you the contact information for a one-on-one consultation. https://houston.naturalizenow.org/ Obtain consent from the caller: ask the caller, Would you like to be added to the call back list for a legal screening? If yes, add the caller to the referral list (Excel sheet) then, inform the caller, You have been added to a wait list for a legal screening and someone from Pathways will be calling you to conduct a legal screening. We do not manage this wait list so we cannot inform you of the status of this referral. This is not a promise or guarantee of a legal representation. Spanish - Obtain consent from the caller: ask the caller, quiere recibir una consulta legal? If the answer is yes, inform the caller: Puse su información en una lista para recibir una consulta legal; alguien de servicios legales (Pathways) le va a llamar para conducir una consulta legal. Nosotros no administramos esta lista de espera y no podemos darle información acerca del estatus de espera. No es una promesa o garantÃa de representación legal. https://hilsc-my.sharepoint.com/:x:/g/personal/admin_houstonimmigration_org/IQAffpC3WnL8T610RqEgROQ8AWxtrauAChy295yelElAfRA?e=y1IGWh Did caller ask to be referred to an attorney?(Required)ChooseYesNoWhat referrals and/or resources do you provide to the caller?(Required) None needed LSP List Private Attorney List Citizenship information Scheduled for Citizenship Workshop Scheduled for Citizenship consultation Social services resources Information on immigration court Information for loved ones in detention Information on detained immigration proceedings Added to ILSF database Notes
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