Asylum Application Intake

Please provide your information to begin the application process

Personal Information

Basic details about yourself

Full Name *

Date of Birth

Email Address *

Phone Number

Country of Origin *

Languages Spoken

English

Spanish

French

Arabic

Mandarin

Other

Emergency Contact

Someone we can contact on your behalf

Contact Name

Contact Phone

Case Summary *

Please describe your situation and reasons for seeking asylum

This information will be reviewed by our intake specialists. Please be as detailed as possible.

Privacy Notice: All information provided is confidential and will only be used for processing your asylum application. Your data is protected under applicable privacy laws.