Referral to the San Diego Regional Network Hub Community Education

This form is for community members, service providers, including local government organizations, and partner organizations who would like to request immigration educational presentations.

By submitting this form, you can request a presentation for your community and suggest topics you would like covered. If the requested topic falls outside the expertise of the organizations involved in this community education collaboration, we will do our best to refer you to other trusted organizations with the relevant expertise.

We ask that you submit your request at least three weeks in advance to help us plan and assess capacity. While we aim to accommodate as many request as possible we cannot guarantee availability due to our team's limited capacity. If we are unable to respond to your request due to capacity limitations, we can see if we are able to refer your to other trusted organizations that have expertise to respond to these requests.

Your Full Name

Name of your Organization

If you are not affiliated with an organization/entity, please write N/A

Your Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Your Email

example@example.com

Is this request affiliated with CSU San Marcos, SDSU or a San Diego Community Colleges as a student, staff, faculty member, or alum?

If yes, please list the college or CSU campus.

Please select the service requested

Please answer the following questions on behalf of your client/individual you are referring, to the best of your abilities. These questions will help us assess the individual's situation and the services they may be eligible for.

Completion of this form does not create an attorney-client relationship. The legal team reviewing submissions is not representing the individual at this time, and assistance cannot be guaranteed in every matter. It is strongly advised that individuals continue to actively seek legal assistance elsewhere.

Full name of individual you are referring

Individual's email

example@example.com

Individual's phone number

Please enter a valid phone number.Format: (000) 000-0000.

Country of Origin

Preferred Language

Is this individual or their immediate family member currently detained in an ICE detention facility and/or facing removal proceedings?

Date of Birth

Date

A #

Immigration Status

How long has the individual been in the United States?

Please briefly describe the individual's immigration situation and/or the immigration service they are seeking.

Is this individual a student, faculty, or staff at a local community college?

Is this individual a student, faculty, or staff at a California State University? Or do they have an immediate family member who is?

Where did the arrest take place?

In Public

Detention Status

Other (explain)

Location of immigration document (Notice to Appear/ Form 1-862)

Race/ethnicity

Sexual orientation

Marital status of detained individual

Household income

Please complete the following information about the detained individual's immediate family (spouse/partner, children, parents, siblings) in the U.S.

Rows	Relationship	Age	Immigration Status
Family Member #1
Family Member #2
Family Member #3
Family Member #4
Family Member #5
Family Member #6
Family Member #7
Family Member #8
Family Member #9
Family Member #10

We're happy to provide you with an educational presentation. Please fill out the following information so we can better prepare the presentation to your needs. We will contact you to finalize the details.

Did you connect with a specific organization about this presentation, or is there an organization you'd like to invite to present?

Organizations working together on the Community Education Project are: UURISE, Casa Familiar, North County LGBTQ+ Resource Center & JFSSD.

Will this be an in-person, virtual, or hybrid presentation?

Location of presentation (if in person or hybrid)

Preferred language of presentation?

Please describe further details about language needs if applicable.

Estimated number of attendees?

Please briefly describe the audience of presentation (is this presentation for staff, community members, parents of students, etc.?)

Do you have preferred dates and times for this presentation to take place?

Please list immigration topics you want cover for your presentation.

Please select the needed resources

Please further describe the individual's situation/need:

Additional information: is there anything else you would like to us to know?

Referral to the San Diego Reginal Network Hub Community Education