Intake Form

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Tell Us How We Can Help

This brief form helps FIJF understand your immediate needs and determine whether your request may qualify for assistance.

Name

Please provide your full name.

This field is required.

Phone

Please provide a contact number.

This field is required.

Please provide your email address for further communication.

This field is required.

Who are you requesting help for?

Select one of the options below.

Myself

Someone else

This field is required.

If someone else, what is your relationship to this person?

Please specify your relationship.

This field is required.

What kind of help is needed?

Select the type of help you are requesting.

Immigration legal fees or representation

Bond or detention-related assistance

Emergency family needs (food, housing, utilities, etc.)

Other

This field is required.

If Other, please specify:

Please describe briefly.

This field is required.

Briefly tell us what is happening and what help is needed:

Provide a brief description of your situation and the assistance you need.

This field is required.

Attorney or legal organization, if applicable:

If you have an attorney, please provide their name or the legal organization.

This field is required.

Amount of assistance needed, if known:

Enter the amount of assistance you believe is needed.

What Happens Next?

This form is an initial intake only and is used to help FIJF determine whether a request falls within our areas of assistance and may be eligible for further consideration.

If your request moves forward, you will be asked to complete a more detailed assistance application before FIJF can approve or make any payment on your behalf.

By submitting this form, you understand that FIJF does not guarantee financial assistance and does not provide legal advice or legal representation. Information shared with FIJF will be handled with care and in accordance with our confidentiality policies.

Need the complete application? You may download the full Request for Assistance form below.

FULL ASSISTANCE APPLICATION