Volunteer Lawyers Network SIJS Custody Project

Referral for custody of minor under 18

Name of referring attorney/professional: Click or tap here to enter text.

Referring attorney’s phone: Click or tap here to enter text. Email: Click or tap here to enter text.

Date referral made: Click or tap to enter a date. Interpreter needed? ☐Y ☐N What language?

Is referring attorney able to review state court pleadings and help prepare child’s affidavit? ☐Y ☐N

Please provide as much detail as possible in narrative sections. This will facilitate a faster and more efficient referral and placement process. If you have questions about the program, please contact Luce Guillén-Givins at Volunteer Lawyers Network. Phone: (612) 752-6667; Email: Luce@vlnmn.org; Fax: “Attn: Luce” to 612-752-6656

INFORMATION ABOUT THE PROPOSED CUSTODIAN (“CLIENT”)

Name: Click or tap here to enter text.

(Last, First Middle)

DOB (Month/Day/Year): Click or tap to enter a date. Country of birth: Click or tap here to enter text.

Gender: Click or tap here to enter text. Marital status: Click or tap here to enter text.

Client’s immigration status: Click or tap here to enter text.

Client’s primary language: Click or tap here to enter text.

Client’s relationship to child: Click or tap here to enter text.

County of residence: Click or tap here to enter text.

Client’s address (Street/City/State/ZIP): Click or tap here to enter text.

Safe to send mail to this address? ☐Y ☐N

Client’s phone number(s): Click or tap here to enter text. Safe to leave messages? ☐Y ☐N

Best day and time of day to reach client: Click or tap here to enter text.

Client’s email (only if client uses email regularly): Click or tap here to enter text. Safe to email? ☐Y ☐N

Client’s living situation (who, relationship, how long): Click or tap here to enter text.

INFORMATION ABOUT PROPOSED CUSTODIAN’S IMMIGRATION STATUS

Is proposed custodian currently in removal proceedings? ☐Y ☐N

Is proposed custodian represented by an immigration attorney? ☐Y ☐N

If yes, who? Click or tap here to enter text. Can this attorney advise proposed custodian on potential risks of filing the state court action? ☐Y ☐N

Does proposed custodian need an independent consultation on potential risks of filing the state court action? ☐Y ☐N

Please flag any potential immigration-related risks you have identified for the proposed custodian.

PROPOSED CUSTODIAN IS AT HEIGHTENED RISK OF DEPORTATION OR PROSECUTION DUE TO:

☐ Prior removal order

(If yes, explain: Click or tap here to enter text.)

☐ Criminal/arrest record

(If yes, explain: Click or tap here to enter text.)

☐ Participation in arranging child’s journey to US

(If yes, explain: Click or tap here to enter text.)

PROPOSED CUSTODIAN MAY BE EXPOSED TO FURTHER RISK VIA:

☐ ORR sponsorship

(If yes, explain: Click or tap here to enter text. )

☐ Filing in state court

(If yes, explain:Click or tap here to enter text.)

☐ Providing oral/ written testimony in support of child’s asylum application

(If yes, explain: Click or tap here to enter text.)

☐ Accompanying child to immigration-related appointments

(If yes, explain: Click or tap here to enter text.)

☐ Other

(If yes, explain: Click or tap here to enter text.)

INFORMATION ABOUT THE CHILD

Name: Click or tap here to enter text.

(Last, First Middle)

DOB (Month/Day/Year): Click or tap to enter a date. Gender: Click or tap here to enter text.

Child 17 years old? ☐Y ☐N Date the Child Turns 18? Click or tap to enter a date.

Country of birth:Click or tap here to enter text. Child’s primary language: Click or tap here to enter text.

Does the child have a copy of birth certificate? ☐Y ☐N Are both parents listed on it? ☐Y ☐N

Child in removal proceedings? ☐Y ☐N Next court date: Click or tap here to enter text.

If no, does potential benefit of SIJS application outweigh potential risk of exposure? ☐Y ☐N Explain: Click or tap here to enter text.

Does the child attend school? ☐Y ☐N If yes, where and what grade? Click or tap here to enter text.

Does the child have contact with parent(s)? Describe frequency if current, or last contact if not:

Mother: Click or tap here to enter text.

Father: Click or tap here to enter text.

Have there been any custody/other court actions (USA or abroad) concerning the child? ☐Y ☐N

If yes, provide documents and details (what kind of action, in which county, state, country did the action take place, when did the action take place, etc…) Click or tap here to enter text.

With whom does the child live? ☐Proposed custodian ☐Other: Click or tap here to enter text.

How long has child been living with proposed custodian? Click or tap here to enter text.

How long has child been living in Minnesota? Click or tap here to enter text.

How long has child been living in the United States? Click or tap here to enter text.

TIMELINE/DEADLINES

Is a signed predicate order required within the next six months? (e.g., Does the child age out soon? Is there a final removal hearing? Etc.)

☐Y ☐N If yes, explain (when, why, etc.): Click or tap here to enter text.

ADVERSE PARTIES AND SERVICE

Service on all parties is required in family court, and Service by Alternate Means is only granted after exhaustive efforts to locate all parties. If a parent’s current whereabouts is unknown, please provide information about last know location and/or other people who may be able to assist in locating the party. VLN may not be able to accept cases where service cannot be completed.

Are parents willing to sign a document accepting service? ☐Y ☐N Other: Click or tap here to enter text.

If not, is there someone where they live that can assist with completing service? ☐Y ☐N Other: Click or tap here to enter text.

Mother’s name: Click or tap here to enter text. DOB: Click or tap to enter a date.

Address/country, or last known: Click or tap here to enter text.

Father’s name:Click or tap here to enter text. DOB: Click or tap to enter a date.

Address/country, or last known: Click or tap here to enter text.

Do parents reside together? ☐Y ☐N

If one of both parents’ addresses is unknown, please ask about relatives, friends, or others who may know how to find the parent or who could receive service for the parent. Explain the situation below:

Additional adverse parties (include DOB & relationship): Click or tap here to enter text.

CASE SUMMARY

Please provide a case summary explaining the child’s background, how the child came to be in the current living situation; why it is in the child’s best interest for this custodian to have full legal custody; and the history of the relationship between the child and proposed custodian.

Click or tap here to enter text.

PROPOSED CUSTODIAN IS A BIOLOGICAL PARENT

Were the mother and father legally married at the time the child was born? ☐Y ☐N

If yes, are they legally divorced? ☐Y ☐N Does the client have any documentation? ☐Y ☐N

Is father listed as such on the birth certificate? ☐Y ☐N

If the parties were not legally married when the child was born and/or father is not listed on the birth certificate, please answer the following:

Are there any legal documents showing the father/child relationship (e.g., adjudication of paternity, child support order, protective order, etc.)? ☐Y ☐N

Was paternity established another way? ☐Y ☐N If yes, explain: Click or tap here to enter text.

Does Minnesota have personal jurisdiction over the father? ☐Y ☐N Explain: Click or tap here to enter text.

Will the father sign a document acknowledging paternity? ☐Y ☐N

If paternity is not/cannot be established, VLN may not be able to accept the case. In some cases where paternity is not/cannot be established, VLN may review whether it’s possible to seek a custody order with SIJS findings, without seeking a paternity adjudication.

Would a predicate order with no paternity adjudication be sufficient for the child’s SIJS application? ☐Y ☐N ☐N/A

CHILDREN LIVING WITH SOMEONE OTHER THAN A BIOLOGICAL PARENT

Is the child’s biological mother deceased? ☐Y ☐N If yes, is death certificate available? ☐Y ☐N

Is the child’s biological father deceased? ☐Y ☐N If yes, is death certificate available? ☐Y ☐N

Has the child resided with the custodian within the last 24 months without a parent present and with a lack of demonstrated consistent participation of a parent for [Minn. Stat. § 257C.01 subdiv. 2]:

☐ Six months or more, which need not be consecutive, if the child is under three years of age;

☐ One year or more, which need not be consecutive, if the child is three years of age or older.

☐ N/A

Does the child’s parent(s) provide food, clothing, shelter, health care, education, and have they created a “nurturing and consistent relationship” [Minn. Stat. § 257C.01 subdiv. 2(c)]? ☐Y ☐N

Do one or more of the following circumstances exist? See Minn. Stat. § 257C.03 subdiv. 7.

Check all that apply and explain below.

☐ The parent(s) has (have) abandoned, neglected, or otherwise exhibited disregard for the child's well-being to the extent that the child will be harmed by living with the parent(s);

☐ Placement of the child with the proposed custodian takes priority over preserving the day-to-day parent-child relationship because of the presence of physical or emotional danger to the child, or both; or

☐ Extraordinary circumstances make the proposed custodian an “interested third party”

Explanation: Click or tap here to enter text.

BASIS FOR SPECIAL IMMIGRANT JUVENILE FINDINGS

Note that findings must be made against both parents in cases of 3rd Party Custody.

Is reunification with ☐ONE or ☐BOTH of the child’s parents not viable due to abuse, neglect, or abandonment, or a similar basis under Minnesota law? Explain: Click or tap here to enter text.

Is it not in the child’s best interest to be returned to his/her country of origin? Explain: Click or tap here to enter text.

OTHER USEFUL/IMPORTANT INFORMATION, IF ANY.

Click or tap here to enter text.

PLEASE SEND THE COMPLETED REFERRAL FORM TO: luce@vlnmn.org

AUTHORIZATION FOR RELEASE OF INFORMATION

I,	, hereby authorize	[child’s name]

,	,

[referring attorney or staff name]	[referring staff title/position]

and	to release any and all information

[referring agency/organization/firm]

regarding me in its possession to the Volunteer Lawyers Network (VLN). I also authorize release of information to the pro bono attorney with whom VLN places my guardian’s custody case.

The purpose of this release is so that VLN can assess whether it can place my guardian’s custody case, so that the pro bono attorney can effectively work on this case, and so that VLN can obtain information about the outcome of the immigration case.

This authorization shall remain in effect at least as long as my immigration case is pending, and long enough thereafter for VLN to obtain information about the outcome of the case.

“X”

Date

“X”

Signature

AUTORIZACIÓN DE LA DIVULGACIÓN DE INFORMACIÓN

Por la presente, yo,	, autorizo a	[nombre del niño/joven]

,	,

[nombre del abogado de inmigración, o del remitente]	[posición/título del abogado de inmigración, o del remitente]

y	a divulgar cualquier y toda información referente a mi caso legal la cual está en su posesión, a la Red de Abogados Voluntarios (‘VLN’ por sus siglas en inglés). También le autorizo a divulgar la información al abogado voluntario a quien VLN asigna el caso de custodia de mi tutor.

El propósito de esta autorización es permitir a VLN evaluar si pueden tomar el caso de custodia de mi tutor, ayudar al abogado voluntario tramitar el caso eficazmente, y permitir a VLN obtener información sobre el resultado del caso de inmigración.

Esta autorización permanecerá en efecto mientras que mi caso de inmigración está en trámite, y con suficiente tiempo después de que se resuelva para que VLN pueda obtener información sobre el resultado del caso.

“X”

Fecha

“X”

Firma