Pages
1-2,
Part
2. Eligibility Information for Attorney or Accredited
Representative
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[Page
1]
Part
2. Eligibility Information for Attorney or Accredited
Representative
Select
all
applicable
items:
1.A.
I
am an attorney eligible to practice law in, and a member in good
standing of, the bar of the highest courts of the following
states, possessions, territories, commonwealths, or the District
of Columbia. If you need to provide information for more than
three jurisdictions, use the space provided in Part
6. Additional Information.
Jurisdiction
[fillable field] Bar Number (if applicable) [fillable field]
Jurisdiction
[fillable field] Bar Number (if applicable) [fillable field]
Jurisdiction
[fillable field] Bar Number (if applicable) [fillable field]
B.
I (select only
one
box) [] am not [] am subject to any order suspending, enjoining,
restraining, disbarring, or otherwise restricting me in the
practice of law. If you are subject to any orders, use the space
provided in Part
6. Additional Information
to provide an explanation.
…
[Page
2]
4.A.
I
am a law student or law graduate working under the direct
supervision of the attorney or accredited representative of record
on this form in accordance with the requirements in 8 CFR
292.1(a)(2).
…
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[Page
1]
Part
2. Eligibility Information for Attorney or Accredited
Representative
Select
all
applicable
items:
1.A.
I
am an attorney eligible to practice law in, and a member in good
standing of, the bar of the highest courts of the following
states, possessions, territories, commonwealths, or the District
of Columbia. If you need to provide information for more than
three jurisdictions, use the space provided in Part
8.
Additional Information.
Jurisdiction
[fillable field] Bar Number (if applicable) [fillable field]
Jurisdiction
[fillable field] Bar Number (if applicable) [fillable field]
Jurisdiction
[fillable field] Bar Number (if applicable) [fillable field]
B.
I (select only
one
box) [] am not [] am subject to any order suspending, enjoining,
restraining, disbarring, or otherwise restricting me in the
practice of law. If you are subject to any orders, use the space
provided in Part
8.
Additional Information
to provide an explanation.
…
[Page
2]
4.A.
I
am a law student or law graduate working under the direct
supervision of the attorney or accredited representative of record
named in Part
1.,
Item Number 2.,
at the law firm named in Part
2.,
Item Number 1.C.
on this form in accordance with the requirements in 8 CFR
292.1(a)(2).
…
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New
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[Page
2]
Part
3. Designated Paralegal for Limited Interaction with USCIS for
Customer Service Purposes
Attorney
or accredited representative of record in Part
1.,
Item Number 2.
to include the name of the designated paralegal working under the
direct supervision of the attorney or accredited representative of
record named in Part
1.,
Item Number 2.
and at the law firm or recognized organization named in Part
2.,
Item Number 1.C.
The attorney or accredited representative of record in
Part 1.,
Item Number 2
and the client named in Part
5.
of this form have specifically authorized the designated paralegal
named in Item
Number 1.
below to engage in limited interaction with USCIS customer service
channels as specified in the form instructions.
Name
of Paralegal
1.
Family Name (Last Name)
Given
Name (First Name)
Middle
Name
Contact
Information of Paralegal
2.
Daytime Telephone Number
3.
Mobile Telephone Number (if any)
4.
Email Address (if any)
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Pages 2-3,
Part 3. Notice of
Appearance as Attorney or Accredited Representative
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[Page
2]
Part
3. Notice of Appearance as Attorney or Accredited Representative
If
you need extra space to complete this section, use the space
provided in Part
6. Additional Information.
…
5.
I enter my appearance as an attorney or accredited representative
at the request of the (select only
one
box):
[]
Applicant
[]
Petitioner
[]
Requestor
[]
Beneficiary/Derivative
[]
Respondent
Information
About Client (Applicant, Petitioner, Requestor, Beneficiary or
Derivative, Respondent, or Authorized Signatory for an Entity)
6.
Family Name (Last Name)
Given
Name (First Name)
Middle
Name
7.
Name of Entity (if applicable)
8.
Title of Authorized Signatory for Entity (if applicable)
9.
Client’s USCIS Online Account Number (if any)
10.
Client’s Alien Registration Number (A-Number) (if any)
[Page
3]
Client’s
Contact Information
11.
Daytime Telephone Number
12.
Mobile Telephone Number (if any)
13.
Email Address (if any)
Mailing
Address of Client
NOTE:
Provide
the client's mailing address. Do
not
provide the business mailing address of the attorney or accredited
representative unless
it serves as the safe mailing address on the application or
petition being filed with this Form G-28.
14.
Street Number and Name
Apt./Ste./Flr.
[Fillable field]
City
or Town
State
ZIP
Code
Province
Postal
Code
Country
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[Page 2]
Part
4.
Notice of Appearance as Attorney or Accredited Representative
If
you need extra space to complete this section, use the space
provided in Part
8.
Additional Information.
…
5.
I enter my appearance as an attorney or accredited representative
at the request of the (select only
one
box):
[]
Applicant
[]
Petitioner
[]
Requestor
[]
Beneficiary/Derivative
[]
Respondent
[moved
down to Part 5]
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New
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[Page
2]
[moved
down from above]
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[Page
3]
Part
5. Information
About Client (Applicant, Petitioner, Requestor, Beneficiary or
Derivative, Respondent, or Authorized Signatory for an Entity)
1.
Family Name (Last Name)
Given
Name (First Name)
Middle
Name
2.
Name
of Entity (if applicable)
3.
Title of Authorized Signatory for Entity (if applicable)
4.
Client’s USCIS Online Account Number (if any)
5.
Client’s Alien Registration Number (A-Number) (if any)
Client’s
Contact Information
6.
Daytime Telephone Number
7.
Mobile Telephone Number (if any)
8.
Email Address (if any)
Client’s
Mailing Address
NOTE:
Provide
the client's mailing address. Do
not
provide the business mailing address of the attorney or accredited
representative unless
it serves as the safe mailing address on the application or
petition being filed with this Form G-28.
9.
Street
Number
and Name
Apt./Ste./Flr.
[Fillable field]
City
or Town
State
ZIP
Code
Province
Postal
Code
Country
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Page 3,
Part 4. Client’s
Consent to Representation and Signature
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[Page
3]
Part
4. Client’s Consent
to Representation and Signature
Consent
to Representation and Release of Information
I
have requested the representation of and consented to being
represented by the attorney or accredited representative named in
Part
1.
of this form. According to the Privacy Act of 1974 and U.S.
Department of Homeland Security (DHS) policy, I also consent to
the disclosure to the named attorney or accredited representative
of any records pertaining to me that appear in any system of
records of USCIS, ICE, or CBP.
[new]
Options
Regarding Receipt of USCIS Notices and Documents
USCIS
will send notices to both a represented party (the client) and
their attorney or accredited representative either through mail or
electronic delivery. USCIS will send all secure identity documents
and Travel Documents to the client's U.S. mailing address.
If
you want to have notices and/or secure identity documents sent to
your attorney or accredited representative of record rather than
to you, please select all
applicable
items below. You may change these elections by submitting a new
Form G-28 to USCIS.
1.A.
I request that USCIS send original notices on an application or
petition to the business address of my attorney or accredited
representative as listed in this form.
B. I request that USCIS
send any secure identity document (Permanent Resident Card,
Employment Authorization Document, or Travel Document) that I
receive to the U.S. business address of my attorney or accredited
representative (or to a designated military or diplomatic address
in a foreign country (if permitted)).
NOTE:
If your notice contains Form I-94, Arrival-Departure Record, USCIS
will send the notice to the U.S. business address of your attorney
or accredited representative. If you would rather have your Form
I-94 sent directly to you, select Item
Number 1.c.
C.
I
request that USCIS send my notice containing Form I-94,
Arrival-Departure Record, to me at my U.S. mailing address.
Signature
of Client or Authorized Signatory for an Entity
2.
Signature of Client or Authorized Signatory for an Entity
Date
of Signature (mm/dd/yyyy)
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[Page
4]
Part
6.
Client’s
Consent to Representation and Signature
Consent
to Representation and Release of Information
1.A.
I
have requested the representation of and consented to being
represented by the attorney or accredited representative named in
Part
1.
of this form. According to the Privacy Act of 1974 and U.S.
Department of Homeland Security (DHS) policy, I also consent to
the disclosure to the named attorney or accredited representative
of any records pertaining to me that appear in any system of
records of USCIS, ICE, or CBP.
B.
I have authorized the designated paralegal named in Part
3.
of this form to engage in limited interaction with USCIS customer
service channels. According to the Privacy Act of 1974 and U.S.
Department of Homeland Security (DHS) policy, I also consent to
the disclosure to the named paralegal of any records pertaining to
me related to the forms or specific matter listed in Part
4.
of this form that appear in any USCIS system of records.
Options
Regarding Receipt of USCIS Notices and Documents
USCIS
will send notices to both a represented party (the client) and
their attorney or accredited representative either through mail or
electronic delivery. USCIS will send all secure identity documents
and Travel Documents to the client's U.S. mailing address.
If
you want to have notices and/or secure identity documents sent to
your attorney or accredited representative of record rather than
to you, please select all
applicable
items below. You may change these elections by submitting a new
Form G-28 to USCIS.
2.A.
I request that USCIS send original notices on an application or
petition to the business address of my attorney or accredited
representative as listed in this form.
B.
I request that USCIS send any secure identity document (Permanent
Resident Card, Employment Authorization Document, or Travel
Document) that I receive to the U.S. business address of my
attorney or accredited representative (or to a designated military
or diplomatic address in a foreign country (if permitted)).
NOTE: If your notice contains
a Form I-94, Arrival/Departure
Record, USCIS will send the notice to the U.S. business address of
your attorney or accredited representative. If you would rather
have your Form
I-94 sent directly to you, please
select Item Number 3.
3.
I
request that USCIS send my notice containing Form I-94,
Arrival/Departure
Record, to me at my U.S. mailing address.
Signature
of Client or Authorized Signatory for an Entity
4.
Signature
of Client or Authorized Signatory for an Entity
Date
of Signature (mm/dd/yyyy)
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Page 4,
Part 5. Signature of
Attorney or Accredited Representative
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[Page
4]
Part
5. Signature of Attorney or Accredited Representative
I
have read and understand the regulations and conditions contained
in 8 CFR 103.2 and 292 governing appearances and representation
before DHS. I declare under penalty of perjury under the laws of
the United States that the information I have provided on this
form is true and correct.
1. Signature of Attorney or
Accredited Representative
Date of Signature (mm/dd/yyyy)
2. Signature of Law Student
or Law Graduate
Date
of Signature (mm/dd/yyyy)
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[Page
4]
Part
7.
Signature of Attorney,
Accredited Representative,
Law Student, or Law Graduate
I
have read and understand the regulations and conditions contained
in 8 CFR 103.2 and 292 governing appearances and representation
before DHS,
I acknowledge that I am subject to the disciplinary rules and
procedures at 8 CFR 292.3, including, pursuant to 8 CFR sections
292.3(h)(3), 1003.108(c), authorizing/permitting publication of my
name and findings of misconduct should I be subject to any public
discipline. I
declare under penalty of perjury under the laws of the United
States that the information I have provided on this form is true
and correct.
1. Signature of Attorney or
Accredited Representative
Date of Signature (mm/dd/yyyy)
2. Signature of Law Student
or Law Graduate
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