EOIR-56 Screenshots 2019

T H E U N I T E D S TAT E S

HOM E

D E PA RT M E N T O F J U S T I C E

Pro Bono List Application
Non-Profit Organization
1

Application Type

2

Immigration Court

3

Applicant Location Information

4

Specialties & Limitations

5

Representative Information

6

Attachments
Declaration

7

Review

1.

AP P L I CATI ON

Application Type for Non-Profit Organization

What type of application are you submitting?

Initial Application
Renewal Application

(Every 3 Years)

CONT I N U E

Contact OLAP

© 2019 U.S. D E PA RT M E N T O F J U ST I C E

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Pro Bono List Application
Non-Profit Organization
1

Immigration Court

3

Applicant Location Information

4

Specialties & Limitations

FA Q

2. Immigration Court

Select Immigration Court

Application Type

2

AP P L I CATI ON

Indicate below the name(s) of each immigration court where the applicant intends to provide at least 50 hours of pro bono legal services annually. Pro
bono legal services are those uncompensated legal services performed for indigent individuals or the public good without any expectation of either
direct or indirect remuneration, including referral fees (other than filing fees or photocopying and mailing expenses), although a representative may be
regularly compensated by the firm, organization, or pro bono referral service with which he or she is associated. Every three years, upon renewal,
applicants will be required to submit a list of alien registration numbers (A#s) for clients to whom they have provided pro bono legal services, totaling 50
hours per year per immigration court. Providers may only count hours spent on cases before EOIR where the attorney or representative has filed an E-28.
Those hours may include both in-court and out-of-court preparation time.

Add Immigration Court
5

Representative Information

6

Attachments
Declaration

7

Review

Contact OLAP

© 2019 U.S. D E PA RT M E N T O F J U ST I C E

State *

BACK

Court *

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Pro Bono List Application
Non-Profit Organization
1

Application Type

2

Immigration Court

3

Applicant Location Information

Select information to display on the Pro Bono List for the
[Immigration Court Name]:
INFORMATION POPULATED FROM PROFILE. CLICK HERE TO UPDATE

Location #1
Phone Number #1

Specialties & Limitations

5

Representative Information

6

Attachments
Declaration

7

FA Q

3. Applicant Location Information

Full Address

4

AP P L I CATI ON

Review

Email Address

Location #2
Full Address

Phone Number #1

Email Address

Location #3
Full Address

Contact OLAP

Phone Number #1

Email Address
Display website for this court

BACK

© 2019 U.S. D E PA RT M E N T O F J U ST I C E

CONT I N U E

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Pro Bono List Application
Non-Profit Organization
1

Application Type

2

Immigration Court

3

Applicant Location Information

4

Specialties & Limitations

5

Representative Information

6

Attachments
Declaration

7

Review

AP P L I CATI ON

FA Q

4. Specialties & Limitations

If applicable, add specialties and limitations to the
following location(s):
Select All
Location #1
Full Address

Location #2
Full Address

Location #3
Full Address

Add Specialties & Limitations

Contact OLAP

© 2019 U.S. D E PA RT M E N T O F J U ST I C E

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Pro Bono List Application
Non-Profit Organization
1

Application Type

2

Immigration Court

AP P L I CATI ON

FA Q

4. Specialties and Limitations

Select location(s) to add specialties and limitations:
Select Specialties & Limitations
Location #1

Will not represent individuals in detention
430 S Broadway,
MD 21231
Detention
facilityBaltimore,
speed dial
code

Applicant Location Information
4

Will not represent individuals with criminal cases

Specialties & Limitations

Languages spoken
No walk-ins
Location
#2

5

Representative Information

Please call for an appointment
5859 hours
Allentown Way, Temple Hills, MD 20748
Intake

6

Attachments
Declaration

Specialize in

7

Representation limited to residents of

Location
Other#3

Review

1618 Monroe Street N.W., Washington, DC 20010

SAVE

Contact OLAP
BACK

© 2019 U.S. D E PA RT M E N T O F J U ST I C E

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Pro Bono List Application
Non-Profit Organization
1

Application Type

2

Immigration Court

3
4
5
6
7

Applicant Location Information

AP P L I CATI ON

FA Q

5. Representative Information

Provide the following information for the attorney(s) and/or fully accredited representative(s) who will be providing pro bono legal services to meet the 50-hour requirement.

Representative #1

Representative #2

Type *

Full Name
Salutation

First Name *

Middle Name

Last Name *

Specialties & Limitations
Representative Information
Attachments
Declaration

EOIR ID
EOIR ID *

© 2019 U.S. D E PA RT M E N T O F J U ST I C E

Jurisdiction

Bar #
+Add Another Representative

Review

Contact OLAP

This field auto-populates from eRegistry

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Pro Bono List Application
Non-Profit Organization
1

Application Type

AP P L I CATI ON

FA Q

6. Attachments | Declaration
Attachments

If necessary, attach any additional documentation in support of your application here.
(Note: Max file size is 2MB and only pdf format allowed)

2

Immigration Court

+Add Attachment

Declaration
3

Applicant Location Information

4

Specialties & Limitations

5

Representative Information

6

Attachments
Declaration

7

Review

Contact OLAP

© 2019 U.S. D E PA RT M E N T O F J U ST I C E

By signing this form, the non-profit organization hereby certifies its eligibility to be included on the List. The applicant organization
affirms that:
It will provide annually at least 50 hours of pro bono legal services through its attorneys or fully accredited representatives to
individuals in proceedings in each immigration court listed in Part 2.
Every attorney and accredited representative who will represent clients pro bono before EOIR on behalf of the organization is
eRegistered with EOIR.
No attorney or accredited representative who will provide pro bono legal services on behalf of the organization in cases pending
before EOIR is under an order of suspension, disbarment, or other restriction limiting his/her practice of law.
It will update its contact information or eligibility status within ten days pursuant to 8 C.F.R. § 1003.66.
Under penalty of perjury, I declare: I am the authorized officer of [PLACE HOLDER FOR PROVIDER NAME]; I have examined this form,
including the affirmations and accompanying attachments, if any; and, to the best of my knowledge and belief, it is true, correct, and
complete.
I have read and understood these statements

Signature of Authorized Officer *

Title of Authorized Officer *

Email *

Phone Number *

BACK

Date *

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Pro Bono List Application
Non-Profit Organization
1

AP P L I CATI ON

FA Q

7. Review

Review Your Application

Application Type

PROVIDER TYPE
2

Immigration Court

Non-Profit Organization - Initial Application

3

Applicant Location Information

APPLICANT INFORMATION

Specialties & Limitations
5

Name
Name Previously Applied Under

Representative Information

REPRESENTATIVE INFORMATION

6

Attachments
Declaration

Type
Full Name
EOIR ID

7

Review

---

----

DECLARATION
Signed by: -Signed on: --

INFORMATION AS IT WILL APPEAR ON THE PRO BONO LIST
* Non-Profit Organization

Contact OLAP

S T A T E | [Name of Immigration Court]

BLANK

BACK

© 2019 U.S. D E PA RT M E N T O F J U ST I C E

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Pro Bono List Application
Private Attorney
1

Application Type

2

Eligibility Requirements

3

Immigration Court

4

Applicant Location Information

5

Specialties & Limitations

6

Attachments
Declaration

7

Review

1.

AP P L I CATI ON

Application Type for Private Attorney

What type of application are you submitting?

Initial Application
Renewal Application

(Every 3 Years)

CONT IN UE

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© 2019 U.S. D E PA RT M E N T O F J U ST I C E

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Pro Bono List Application
Private Attorney
1

Application Type

2

Eligibility Requirements

3

Immigration Court

4

Applicant Location Information

AP P L I CATI ON

FA Q

2. Eligibility Requirements

Attorneys in private practice are not eligible to be included on the List unless they establish that they cannot provide pro bono legal services through or
in association with a non-profit organization or pro bono referral service. They must declare under penalty of perjury that such organizations or referral
services are unavailable, or that the range of services provided by the existing organizations or referral services is insufficient to address the needs of the
community.
Attorneys must also describe the good-faith, but unsuccessful, efforts that they have made to volunteer and work through, or in association with, a nonprofit organization or referral service. A “good-faith-efforts” declaration should include the phone number, email, physical address, and website for the
organizations/referral services contacted by the attorney, the name of the individual(s) spoken with at the organization(s), and dates and times of those
communications. If the organizations/referral programs are unable to accept a private attorney as a volunteer or refer pro bono immigration court cases
to him or her, the declaration should explain why the organizations/referral programs will not accept his or her assistance.

These fields auto-populate from your profile

5

Specialties & Limitations

6

Attachments
Declaration

7

Review

EOIR ID *

Jurisdiction

Bar #

I have read and understood these eligibility requirements.

CONT IN UE

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© 2019 U.S. D E PA RT M E N T O F J U ST I C E

e n E SPAÑO L

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Pro Bono List Application
Private Attorney
1

Eligibility Requirements

3

Immigration Court

4

Applicant Location Information

5

Specialties & Limitations

6

Attachments
Declaration

7

Review

Contact OLAP

© 2019 U.S. D E PA RT M E N T O F J U ST I C E

FA Q

3. Immigration Court

Select Immigration Court

Application Type

2

AP P L I CATI ON

Indicate below the name(s) of each immigration court where the applicant intends to provide at least 50 hours of pro bono legal services annually. Pro
bono legal services are those uncompensated legal services performed for indigent individuals or the public good without any expectation of either
direct or indirect remuneration, including referral fees (other than filing fees or photocopying and mailing expenses), although a representative may be
regularly compensated by the firm, organization, or pro bono referral service with which he or she is associated. Every three years, upon renewal,
applicants will be required to submit a list of alien registration numbers (A#s) for clients to whom they have provided pro bono legal services, totaling 50
hours per year per immigration court. Providers may only count hours spent on cases before EOIR where the attorney or representative has filed an E-28.
Those hours may include both in-court and out-of-court preparation time.

Add Immigration Court
State *

Court *

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Pro Bono List Application
Private Attorney
1

Application Type

2

Eligibility Requirements

3

Immigration Court

Select information to display on the Pro Bono List for the
[Immigration Court Name]:
INFORMATION POPULATED FROM PROFILE. CLICK HERE TO UPDATE

Location #1
Phone Number #1

Applicant Location Information

5

Specialties & Limitations

6

Attachments
Declaration

7

FA Q

4. Applicant Location Information

Full Address

4

AP P L I CATI ON

Review

Email Address

Location #2
Full Address

Phone Number #1

Email Address

Location #3
Full Address

Contact OLAP

Phone Number #1

Email Address
Display website for this court

B AC K

© 2019 U.S. D E PA RT M E N T O F J U ST I C E

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Pro Bono List Application
Private Attorney
1

Application Type

2

Eligibility Requirements

3

Immigration Court

4

Applicant Location Information

5

Specialties & Limitations

6

Attachments
Declaration

7

Review

AP P L I CATI ON

FA Q

5. Specialties & Limitations

If applicable, add specialties and limitations to the
following location(s):
Select All
Location #1
Full Address

Location #2
Full Address

Location #3
Full Address

Add Specialties & Limitations

Contact OLAP

© 2019 U.S. D E PA RT M E N T O F J U ST I C E

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Pro Bono List Application
Private Attorney
1

Application Type

2

Eligibility Requirements

3

Immigration Court

AP P L I CATI ON

FA Q

6. Attachments | Declaration
Attachments

All attorney applicants must submit a good-faith-effort declaration with their application. See Part 2 and 8 C.F.R. § 1003.63(d)(3) for more
information. Attach, at a minimum, such a declaration and any additional documentation in support of your application here.
(Note: Max file size is 2MB and only pdf format allowed)
+Add Attachment

Declaration

By signing this form, the attorney hereby certifies his or her eligibility to be included on the List. The attorney affirms that:
4

Applicant Location Information

5

Specialties & Limitations

6

Attachments
Declaration

7

Review

He or she will provide annually at least 50 hours of pro bono legal services to individuals in proceedings in each immigration court
listed in Part 3.
He or she is unable to provide pro bono legal services through or in association with a non-profit organization or pro bono referral
service because any such organization or referral service is unavailable or the range of services provided by available organization(s)
or referral service(s) is insufficient to address the needs of the community.
He or she has submitted with this application a description of the good faith efforts he or she made to provide pro bono legal services
through an organization or pro bono referral service to individuals appearing before each immigration court listed in Part 3.
He or she will update his or her contact information or eligibility status within ten days pursuant to 8 C.F.R. § 1003.66.
Under penalty of perjury, I declare: I am a licensed attorney with EOIR ID Number [PLACE HOLDER FOR EOIR NUMBER]; I am not under any
order of suspension, disbarment, or other restriction limiting my practice of law; and I have examined this form, including the
affirmations and accompanying attachment(s), and, to the best of my knowledge and belief, it is true, correct, and complete.
I have read and understood these statements

Signature of Attorney *

Contact OLAP

© 2019 U.S. D E PA RT M E N T O F J U ST I C E

B AC K

Date *

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Pro Bono List Application
Private Attorney
1

AP P L I CATI ON

FA Q

7. Review

Review Your Application

Application Type

PROVIDER TYPE
2

Eligibility Requirements

Private Attorney - Initial Application

3

Immigration Court

APPLICANT INFORMATION

4

Applicant Location Information

5

Specialties & Limitations

6

Attachments
Declaration

7

Review

Name
Name Previously Applied Under
EOIR ID

----

DECLARATION
Signed by: -Signed on: -INFORMATION AS IT WILL APPEAR ON THE PRO BONO LIST
*** Private Attorney

S T A T E | [Name of Immigration Court]

BLANK

Contact OLAP

© 2019 U.S. D E PA RT M E N T O F J U ST I C E

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Pro Bono List Application
Pro Bono Referral Service
1

Application Type

2

Immigration Court

3

Applicant Location Information

4

Specialties & Limitations

5

Attachments
Declaration

6

Review

1.

AP P L I CATI ON

Application Type for Pro Bono Referral Service

What type of application are you submitting?

Initial Application
Renewal Application

(Every 3 Years)

CONT IN UE

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© 2019 U.S. D E PA RT M E N T O F J U ST I C E

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Pro Bono List Application
Pro Bono Referral Service
1

AP P L I CATI ON

FA Q

2. Immigration Court

Select Immigration Court

Application Type

Indicate below the name(s) of each immigration court where the applicant intends to provide pro bono referral services.

2

Immigration Court

3

Applicant Location Information

4

Specialties & Limitations

5

Attachments
Declaration

6

Review

Contact OLAP

© 2019 U.S. D E PA RT M E N T O F J U ST I C E

Add Immigration Court
State *

B AC K

Court *

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Pro Bono List Application
Pro Bono Referral Service
1

Application Type

2

Immigration Court

3

Applicant Location Information
Specialties & Limitations

5

Attachments
Declaration

6

Review

FA Q

3. Applicant Location Information

Select information to display on the Pro Bono List for the
[Immigration Court Name]:
INFORMATION POPULATED FROM PROFILE. CLICK HERE TO UPDATE

Location #1
Full Address

4

AP P L I CATI ON

Phone Number #1

Email Address

Location #2
Full Address

Phone Number #1

Email Address

Location #3
Full Address

Contact OLAP

Phone Number #1

Email Address
Display website for this court

B AC K

© 2019 U.S. D E PA RT M E N T O F J U ST I C E

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Pro Bono List Application
Pro Bono Referral Service
1

Application Type

2

Immigration Court

Specialties & Limitations

5

Attachments
Declaration

6

Review

FA Q

4. Specialties & Limitations

If applicable, add specialties and limitations to the
following location(s):
Select All
Location #1

Applicant Location Information
4

AP P L I CATI ON

Full Address

Location #2
Full Address

Location #3
Full Address

Add Specialties & Limitations

Contact OLAP

© 2019 U.S. D E PA RT M E N T O F J U ST I C E

B AC K

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Pro Bono List Application
Pro Bono Referral Service
1

Application Type

AP P L I CATI ON

FA Q

5. Attachments | Declaration
Attachments

If necessary, attach any additional documentation in support of your application here.
(Note: Max file size is 2MB and only pdf format allowed)

2

Immigration Court
Applicant Location Information

4

Specialties & Limitations

5

Attachments
Declaration

6

Review

Contact OLAP

© 2019 U.S. D E PA RT M E N T O F J U ST I C E

+Add Attachment

Declaration

The applicant pro bono referral service affirms that it will offer services to individuals in immigration court proceedings for each
immigration court listed in Part 2 and update its contact information or eligibility status within ten days pursuant to
8 C.F.R. § 1003.66. By signing this form, the referral service hereby certifies its eligibility to be included on the List.
Under penalty of perjury, I declare: I am the authorized officer of [PLACE HOLDER FOR PROVIDER NAME]; I have examined this
form, including the affirmations and accompanying attachments, if any; and, to the best of my knowledge and belief, it is true,
correct, and complete.
I have read and understood these statements

Signature of Authorized Officer *

Title of Authorized Officer *

Email *

Phone Number *

B AC K

Date *

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Pro Bono List Application
Pro Bono Referral Service
1

AP P L I CATI ON

FA Q

6. Review

Review Your Application

Application Type

PROVIDER TYPE
2

Immigration Court

Pro Bono Referral Service - Initial Application

Applicant Location Information

APPLICANT INFORMATION

4

Specialties & Limitations

5

Attachments
Declaration

6

Review

Name
Name Previously Applied Under

---

DECLARATION
Signed by: -Signed on: --

INFORMATION AS IT WILL APPEAR ON THE PRO BONO LIST
** Pro Bono Referral Service

S T A T E | [Name of Immigration Court]

BLANK

Contact OLAP
B AC K

© 2019 U.S. D E PA RT M E N T O F J U ST I C E

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D E PA RT M E N T O F J U S T I C E

Account Registration for Pro Bono List Applicants
1

21

31

4
2

5
4

PROVIDER TYPE

USER ID

PASSWORD

ACCOUNT INFO

REVIEW

Please specify the provider type:
Non-Profit Organization
Pro Bono Referral Service
Private Attorney

More Info

A non-profit religious, charitable, social service, or similar
group established in the United States.

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D E PA RT M E N T O F J U S T I C E

Account Registration for Pro Bono List Applicants
1

21

31

4
2

5
4

PROVIDER TYPE

USER ID

PASSWORD

ACCOUNT INFO

REVIEW

Create a User ID
User ID *
User ID must have:
8 to 20 characters
letters and/or numbers
User ID may have:
may contain the following special characters: ! $ - _

B AC K

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D E PA RT M E N T O F J U S T I C E

Account Registration for Pro Bono List Applicants
1

21

31

4
2

5
4

PROVIDER TYPE

USER ID

PASSWORD

ACCOUNT INFO

REVIEW

Create Password
Password *
Confirm Password *
Password must have:
8 to 16 characters
At least 1 upper case character (e.g., A, B, C)
At least 1 lower case character (e.g., a, b, c)
At least 1 number (e.g., 1, 2, 3)
At least one of the following special characters:
@#$%^*+=!
Password must not have:
More than two consecutive letters of your first name, middle
name, last name, or User ID
No spaces

B AC K

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D E PA RT M E N T O F J U S T I C E

Account Registration for Pro Bono List Applicants
1

21

31

4
2

5
4

PROVIDER TYPE

USER ID

PASSWORD

ACCOUNT INFO

REVIEW

Provide Account Information
General Information
Organization Name *

Name(s) Previously Applied Under

Website

Location
Street Address *

Unit/Suite #

City *

State *

Phone Number *

Type *

Zip Code *

Email Address *
+Add Another Location

B AC K

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T H E U N I T E D S TAT E S

D E PA RT M E N T O F J U S T I C E

Account Registration for Pro Bono List Applicants
1

21

31

4
2

5
4

PROVIDER TYPE

USER ID

PASSWORD

ACCOUNT INFO

REVIEW

Review Your Registration Information
PROVIDER TYPE

--

USER ID

--

ACCOUNT INFORMATION

Name
Name Previously Applied Under
Website
Location

-----

By submitting this information, I declare under penalty of perjury under the laws of the United States that the information I have provided is true and correct.

B AC K

SUB M IT

T H E U N I T E D S TAT E S

D E PA RT M E N T O F J U S T I C E

Account Registration for Pro Bono List Applicants
1

21

31

4
2

5
4

PROVIDER TYPE

USER ID

PASSWORD

ACCOUNT INFO

REVIEW

Please specify the provider type:
Non-Profit Organization
Pro Bono Referral Service
Private Attorney

More Info

Attorneys in private practice are not eligible to be included
on the List unless they establish that they cannot provide
pro bono legal services through or in association with a
non-profit organization or pro bono referral service. Law
firms are not eligible to appear on the List.

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D E PA RT M E N T O F J U S T I C E

Account Registration for Pro Bono List Applicants
1

21

31

4
2

5
4

PROVIDER TYPE

USER ID

PASSWORD

ACCOUNT INFO

REVIEW

Create a User ID
User ID *
User ID must have:
8 to 20 characters
letters and/or numbers
User ID may have:
may contain the following special characters: ! $ - _

B AC K

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Account Registration for Pro Bono List Applicants
1

21

31

4
2

5
4

PROVIDER TYPE

USER ID

PASSWORD

ACCOUNT INFO

REVIEW

Create Password
Password *
Confirm Password *
Password must have:
8 to 16 characters
At least 1 upper case character (e.g., A, B, C)
At least 1 lower case character (e.g., a, b, c)
At least 1 number (e.g., 1, 2, 3)
At least one of the following special characters:
@#$%^*+=!
Password must not have:
More than two consecutive letters of your first name, middle
name, last name, or User ID
No spaces

B AC K

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D E PA RT M E N T O F J U S T I C E

Account Registration for Pro Bono List Applicants
1

21

31

4
2

5
4

PROVIDER TYPE

USER ID

PASSWORD

ACCOUNT INFO

REVIEW

Provide Account Information
General Information
Salutation

First Name *

Middle Name

Last Name *

Name(s) Previously Applied Under
This field auto-populates from eRegistry

EOIR ID *

Jurisdiction

Bar #

Website

Location
Street Address *

Unit/Suite #

City *

State *

Phone Number *

Type *

Zip Code *

Email Address *
+Add Another Location

B AC K

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Account Registration for Pro Bono List Applicants
1

21

31

4
2

5
4

PROVIDER TYPE

USER ID

PASSWORD

ACCOUNT INFO

REVIEW

Review Your Registration Information
PROVIDER TYPE

--

USER ID

--

ACCOUNT INFORMATION

Full Name
Name(s) Previously Applied Under
EOIR ID
Website
Location

------

By submitting this information, I declare under penalty of perjury under the laws of the United States that the information I have provided is true and correct.

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Account Registration for Pro Bono List Applicants
1

21

31

4
2

5
4

PROVIDER TYPE

USER ID

PASSWORD

ACCOUNT INFO

REVIEW

Please specify the provider type:
Non-Profit Organization
Pro Bono Referral Service
Private Attorney

More Info

A service offered by a non-profit group, association, or
similar organization established in the United States that
assists persons in locating pro bono representation by
making case referrals to attorneys or organizations that are
available to provide pro bono representation in
immigration court proceedings. A service that refers
individuals for paid legal services does not qualify.

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Account Registration for Pro Bono List Applicants
1

21

31

4
2

5
4

PROVIDER TYPE

USER ID

PASSWORD

ACCOUNT INFO

REVIEW

Create a User ID
User ID *
User ID must have:
8 to 20 characters
letters and/or numbers
User ID may have:
may contain the following special characters: ! $ - _

B AC K

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Account Registration for Pro Bono List Applicants
1

21

31

4
2

5
4

PROVIDER TYPE

USER ID

PASSWORD

ACCOUNT INFO

REVIEW

Create Password
Password *
Confirm Password *
Password must have:
8 to 16 characters
At least 1 upper case character (e.g., A, B, C)
At least 1 lower case character (e.g., a, b, c)
At least 1 number (e.g., 1, 2, 3)
At least one of the following special characters:
@#$%^*+=!
Password must not have:
More than two consecutive letters of your first name, middle
name, last name, or User ID
No spaces

B AC K

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Account Registration for Pro Bono List Applicants
1

21

31

4
2

5
4

PROVIDER TYPE

USER ID

PASSWORD

ACCOUNT INFO

REVIEW

Provide Account Information
General Information
Organization Name *

Name(s) Previously Applied Under

Website

Location
Street Address *

Unit/Suite #

City *

State *

Phone Number *

Type *

Zip Code *

Email Address *
+Add Another Location

B AC K

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Account Registration for Pro Bono List Applicants
1

21

31

4
2

5
4

PROVIDER TYPE

USER ID

PASSWORD

ACCOUNT INFO

REVIEW

Review Your Registration Information
PROVIDER TYPE

--

USER ID

--

ACCOUNT INFORMATION

Name
Name Previously Applied Under
Website
Location

-----

By submitting this information, I declare under penalty of perjury under the laws of the United States that the information I have provided is true and correct.

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Pro Bono List Application
Non-Profit Organization
1

Application Type

2

Pro Bono Client Log

3

Review Applicant Information

4

Pro Bono List Information

5

Attachments
Declaration

6

Review

1.

AP P L I CATI ON

Application Type for Non-Profit Organization

What type of application are you submitting?

Initial Application
Renewal Application

(Every 3 Years)

CONT IN UE

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Pro Bono List Application
Non-Profit Organization
1

Application Type

2

Pro Bono Client Log

3

Review Applicant Information

4

Pro Bono List Information

5

Attachments
Declaration

6

Review

List below the 50 hours per year of pro bono legal services provided in the [PLACE HOLDER FOR IMMIGRATION COURT] for the past three years. Pro bono legal
services are those uncompensated legal services performed for indigent individuals or the public good without any expectation of either direct or indirect
remuneration, including referral fees (other than filing fees or photocopying and mailing expenses), although a representative may be regularly compensated by
the firm, organization, or pro bono referral service with which he or she is associated. You may only count hours spent on cases before the immigration court(s)
where an attorney or representative has filed an EOIR-28. Those hours may include both in-court and out-of-court preparation time. Do not include clients served
“low bono” or hours spent on appeals filed before the Board of Immigration Appeals.

[IMMIGRATION COURT NAME]
Year 1 - ##/##/####

##/##/####

Alien Number *

Dates Service Provided *

Name of Attorney or Rep *

##/##/####
Dates Service Provided *

Name of Attorney or Rep *

##/##/####

Alien Number *
Add Individual Represented

B AC K

Hours *

Total Hours: --

Add Individual Represented

Year 3 - ##/##/####

Hours *

Total Hours: --

Add Individual Represented

Alien Number *

© 2019 U.S. D E PA RT M E N T O F J U ST I C E

FA Q

2. Pro Bono Client Log

Year 2 - ##/##/####

Contact OLAP

AP P L I CATI ON

Dates Service Provided *

Name of Attorney or Rep *

Hours *

Total Hours: --

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Pro Bono List Application
Non-Profit Organization
1

Application Type

2

Pro Bono Client Log

3
4

Review and update the following information as necessary.

APPLICANT INFORMATION
Name
Website
Location

Pro Bono List Information
Attachments
Declaration

6

Review

Contact OLAP

© 2019 U.S. D E PA RT M E N T O F J U ST I C E

FA Q

3. Review Applicant Information

Review Applicant Information

5

AP P L I CATI ON

--

EDIT

B AC K

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Pro Bono List Application
Non-Profit Organization
1

Application Type

2

Pro Bono Client Log

3

Review Applicant Information

4
5
6

Review

Contact OLAP

© 2019 U.S. D E PA RT M E N T O F J U ST I C E

FA Q

4. Pro Bono List Information

Review and update how your information
will appear on the Pro Bono List.

S T A T E | [Name of Immigration Court]

BLANK

Pro Bono List Information
Attachments
Declaration

AP P L I CATI ON

EDIT

B AC K

CONFIRM

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Pro Bono List Application
Non-Profit Organization
1

Application Type

2

Pro Bono Client Log

3

Review Applicant Information

AP P L I CATI ON

FA Q

4. Pro Bono Information List

Update and confirm how information will
appear on the Pro Bono List.
What would you like to edit?
S T A T E | [Name of Immigration Court]

Applicant Location
Information
** Pro
Bono Referral Service
Specialties & Limitations

4

BLANK

Pro Bono List Information

5

Attachments
Declaration

6

Review

Contact OLAP

© 2019 U.S. D E PA RT M E N T O F J U ST I C E

EDIT

B AC K

EDIT

CONFIRM

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Pro Bono List Application
Non-Profit Organization
1

Application Type

AP P L I CATI ON

FA Q

5. Attachments | Declaration
Attachments

If necessary, attach any additional documentation in support of your application here.
(Note: Max file size is 2MB and only pdf format allowed)

2

Pro Bono Client Log

+Add Attachment

Declaration
3

Review Applicant Information

4

Pro Bono List Information

5

Attachments
Declaration

6

Review

By signing this form, the non-profit organization affirms under penalty of perjury that:
During the past three years since last approved, it has provided annually at least 50 hours of pro bono legal services through its
attorneys or representatives to individuals in proceedings before each immigration court where it is included on the List.
Every attorney and accredited representative who has represented clients pro bono before EOIR on behalf of the organization is
eRegistered with EOIR.
No attorney or representative who has provided pro bono legal services on behalf of the organization in cases pending before EOIR is
under an order of suspension, disbarment, or other restriction limiting his/her practice of law.
It remains eligible for inclusion on the Pro Bono List and will continue to provide annually at least 50 hours of pro bono legal services
through its attorneys or representatives to individuals in proceedings before each immigration court where it is included on the List.
It will update its contact information or eligibility status within ten days pursuant to 8 C.F.R. § 1003.66.

Under penalty of perjury, I declare: I am the authorized officer of [PLACE HOLDER FOR PROVIDER NAME]; I have examined this form,
including the affirmations and accompanying attachments, if any; and, to the best of my knowledge and belief, it is true, correct, and
complete.
I have read and understood these statements

Signature of Authorized Officer *

Title of Authorized Officer *

Email *

Phone Number *

Date *

Contact OLAP
B AC K

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Pro Bono List Application
Non-Profit Organization
1

AP P L I CATI ON

FA Q

6. Review

Review Your Application

Application Type

PROVIDER TYPE
2

Pro Bono Client Log

Non-Profit Organization - Renewal Application

3

Review Applicant Information

APPLICANT INFORMATION

4

Pro Bono List Information

5

Attachments
Declaration

6

Review

Name
Website
Location

--

RENEWAL APPLICATION
Year 1 - ##/##/####
Year 2 - ##/##/####
Year 3 - ##/##/####

---

##/##/####
##/##/####
##/##/####

----

DECLARATION
Signed by: -Signed on: --

INFORMATION AS IT WILL APPEAR ON THE PRO BONO LIST
* Non-Profit Organization

Contact OLAP
S T A T E | [Name of Immigration Court]

BLANK

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Pro Bono List Application
Private Attorney
1

Application Type

2

Eligibility Requirements

3

Pro Bono Client Log

4

Review Applicant Information

5

Pro Bono List Information

6

Attachments
Declaration

7

Review

1.

AP P L I CATI ON

Application Type for Private Attorney

What type of application are you submitting?

Initial Application
Renewal Application

(Every 3 Years)

CONT IN UE

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Pro Bono List Application
Private Attorney
1

Application Type

2

Eligibility Requirements

3

Pro Bono Client Log

4

Review Applicant Information

AP P L I CATI ON

FA Q

2. Eligibility Requirements

Attorneys in private practice are not eligible to be included on the List unless they establish that they cannot provide pro bono legal services through or
in association with a non-profit organization or pro bono referral service. They must declare under penalty of perjury that such organizations or referral
services are unavailable, or that the range of services provided by the existing organizations or referral services is insufficient to address the needs of the
community.
Attorneys must also describe the good-faith, but unsuccessful, efforts that they have made to volunteer and work through, or in association with, a nonprofit organization or referral service. A “good-faith-efforts” declaration should include the phone number, email, physical address, and website for the
organizations/referral services contacted by the attorney, the name of the individual(s) spoken with at the organization(s), and dates and times of those
communications. If the organizations/referral programs are unable to accept a private attorney as a volunteer or refer pro bono immigration court cases
to him or her, the declaration should explain why the organizations/referral programs will not accept his or her assistance.

These fields auto-populate from your profile

5

Pro Bono List Information

6

Attachments
Declaration

7

Review

EOIR ID *

Jurisdiction

Bar #

I have read and understood these eligibility requirements.

CONT IN UE

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© 2019 U.S. D E PA RT M E N T O F J U ST I C E

e n E SPAÑO L

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Pro Bono List Application
Private Attorney
1

Application Type

2

Eligibility Requirements

3

Pro Bono Client Log

4

Review Applicant Information

5

Pro Bono List Information

6

Attachments
Declaration

7

Review

List below the 50 hours per year of pro bono legal services provided in the [PLACE HOLDER FOR IMMIGRATION COURT] for the past three years. Pro bono legal
services are those uncompensated legal services performed for indigent individuals or the public good without any expectation of either direct or indirect
remuneration, including referral fees (other than filing fees or photocopying and mailing expenses), although a representative may be regularly compensated by
the firm, organization, or pro bono referral service with which he or she is associated. You may only count hours spent on cases before the immigration court(s)
where an attorney or representative has filed an EOIR-28. Those hours may include both in-court and out-of-court preparation time. Do not include clients served
“low bono” or hours spent on appeals filed before the Board of Immigration Appeals.

[IMMIGRATION COURT NAME]
Year 1 - ##/##/####

##/##/####

Alien Number *

Dates Service Provided *

Name of Attorney or Rep *

##/##/####
Dates Service Provided *

Name of Attorney or Rep *

##/##/####

Alien Number *
Add Individual Represented

B AC K

Hours *

Total Hours: --

Add Individual Represented

Year 3 - ##/##/####

Hours *

Total Hours: --

Add Individual Represented

Alien Number *

© 2019 U.S. D E PA RT M E N T O F J U ST I C E

FA Q

3. Pro Bono Client Log

Year 2 - ##/##/####

Contact OLAP

AP P L I CATI ON

Dates Service Provided *

Name of Attorney or Rep *

Hours *

Total Hours: --

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Pro Bono List Application
Private Attorney
1

Application Type

2

Eligibility Requirements

3
4

Review and update the following information as necessary.

APPLICANT INFORMATION
Name
Website
Location

Review Applicant Information

6

Attachments
Declaration

7

Review

Contact OLAP

© 2019 U.S. D E PA RT M E N T O F J U ST I C E

B AC K

----

EDIT
Pro Bono List Information

FA Q

4. Review Applicant Information

Pro Bono Client Log

5

AP P L I CATI ON

CONFIRM

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D E PA RT M E N T O F J U S T I C E

Pro Bono List Application
Private Attorney
1

Application Type

2

Eligibility Requirements

3

Pro Bono Client Log

4

Review and update how your information
will appear on the Pro Bono List.

S T A T E | [Name of Immigration Court]

BLANK
EDIT

Pro Bono List Information

6

Attachments
Declaration

7

Review

Contact OLAP

© 2019 U.S. D E PA RT M E N T O F J U ST I C E

FA Q

5. Pro Bono List Information

Review Applicant Information

5

AP P L I CATI ON

B AC K

CONFIRM

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Pro Bono List Application
Private Attorney
1

Application Type

2

Eligibility Requirements

3

Pro Bono Client Log

AP P L I CATI ON

FA Q

5. Pro Bono Information List

Update and confirm how information will
appear on the Pro Bono List.
What would you like to edit?
S T A T E | [Name of Immigration Court]

Applicant Location
Information
** Pro
Bono Referral Service
Specialties & Limitations

4

BLANK

Review Applicant Information

EDIT
5

Pro Bono List Information

6

Attachments
Declaration

7

Review

Contact OLAP

© 2019 U.S. D E PA RT M E N T O F J U ST I C E

B AC K

EDIT

CONFIRM

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Pro Bono List Application
Private Attorney
1

Application Type

2

Eligibility Requirements

3

Pro Bono Client Log

4

Review Applicant Information

5

Pro Bono List Information

6

Attachments
Declaration

7

Review

AP P L I CATI ON

FA Q

6. Attachments | Declaration
Attachments

All attorney applicants must submit a good-faith-effort declaration with their application. See Part 2 and 8 C.F.R. § 1003.63(d)(3) for more
information. Attach, at a minimum, such a declaration and any additional documentation in support of your application here.
(Note: Max file size is 2MB and only pdf format allowed)
+Add Attachment

Declaration

By signing this form, the attorney affirms under penalty of perjury that:
During the past three years since last approved, he or she has provided annually at least 50 hours of pro bono legal services to
individuals in proceedings before each immigration court where he or she is included on the List.
He or she is unable to provide pro bono legal services through or in association with an organization or pro bono referral service
because any such organization or referral service is unavailable or the range of services provided by the available organization(s) or
referral service(s) is insufficient to address the needs of the community.
He or she has submitted with this application a description of the good faith efforts he or she made to provide pro bono legal services
through an organization or pro bono referral service to individuals appearing before each immigration court where he or she is
included on the List.
He or she remains eligible for inclusion on the Pro Bono List and will continue to provide annually at least 50 hours of pro bono legal
services to individuals in proceedings before each immigration court where he or she is included on the List.
He or she will update his or her contact information or eligibility status within ten days pursuant to 8 C.F.R. § 1003.66.

Under penalty of perjury, I declare: I am a licensed attorney with EOIR ID Number [PLACE HOLDER FOR EOIR NUMBER]; I am not under any
order of suspension, disbarment, or other restriction limiting my practice of law; I have examined this form, including the affirmations
and accompanying attachment(s); and, to the best of my knowledge and belief, it is true, correct, and complete.
I have read and understood these statements

Signature of Attorney *

Date *

Contact OLAP
B AC K

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Pro Bono List Application
Private Attorney
1

AP P L I CATI ON

FA Q

7. Review

Review Your Application

Application Type

PROVIDER TYPE
2

Eligibility Requirements

Private Attorney - Renewal Application

3

Pro Bono Client Log

APPLICANT INFORMATION

4

Review Applicant Information

5

Pro Bono List Information

6
7

Attachments
Declaration

Name
EOIR ID
Website
Location

RENEWAL APPLICATION
Year 1 - ##/##/####
Year 2 - ##/##/####
Year 3 - ##/##/####

##/##/####
##/##/####
##/##/####

-----

----

Review

DECLARATION
Signed by: -Signed on: -INFORMATION AS IT WILL APPEAR ON THE PRO BONO LIST
*** Private Attorney

S T A T E | [Name of Immigration Court]

Contact OLAP

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D E PA RT M E N T O F J U S T I C E

Pro Bono List Application
Pro Bono Referral Service
1

Application Type

2

Review Applicant Information

3

Pro Bono List Information

4

Attachments
Declaration

5

Review

1.

AP P L I CATI ON

Application Type for Pro Bono Referral Service

What type of application are you submitting?

Initial Application
Renewal Application

(Every 3 Years)

CONT IN UE

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© 2019 U.S. D E PA RT M E N T O F J U ST I C E

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Pro Bono List Application
Pro Bono Referral Service
1

Application Type

2

Review Applicant Information

3

Pro Bono List Information

4

Attachments
Declaration

5

AP P L I CATI ON

FA Q

2. Review Applicant Information

Review and update the following information as necessary.

APPLICANT INFORMATION
Name
Website
Location

----

EDIT

CONFIRM

Review

Contact OLAP

© 2019 U.S. D E PA RT M E N T O F J U ST I C E

B AC K

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Pro Bono List Application
Pro Bono Referral Service
1

Application Type

2

Review Applicant Information

3

Pro Bono List Information

4

Attachments
Declaration

5

AP P L I CATI ON

FA Q

3. Pro Bono List Information

Review and update how your information
will appear on the Pro Bono List.

S T A T E | [Name of Immigration Court]

BLANK
EDIT

CONFIRM

Review

Contact OLAP

© 2019 U.S. D E PA RT M E N T O F J U ST I C E

B AC K

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Pro Bono List Application
Pro Bono Referral Service
1

Application Type

2

Review Applicant Information

3

Pro Bono List Information

4
5

Update and confirm how information will
appear on the Pro Bono List.
What would you like to edit?
S T A T E | [Name of Immigration Court]

Applicant Location
Information
** Pro
Bono Referral Service
Specialties & Limitations

BLANK

EDIT

Review

© 2019 U.S. D E PA RT M E N T O F J U ST I C E

FA Q

3. Pro Bono Information List

Attachments
Declaration

Contact OLAP

AP P L I CATI ON

B AC K

EDIT

CONFIRM

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Pro Bono List Application
Pro Bono Referral Service
1

Application Type

AP P L I CATI ON

FA Q

4. Attachments | Declaration
Attachments

If necessary, attach any additional documentation in support of your application here.
(Note: Max file size is 2MB and only pdf format allowed)

2

Review Applicant Information

3

Pro Bono List Information

4

Attachments
Declaration

5

Review

+Add Attachment

Declaration

The applicant pro bono referral service affirms that, during the past three years since last approved, it has referred cases of
respondents appearing before the immigration court(s) identified in its application to attorneys or organizations that provide pro
bono legal services to individuals in removal or other proceedings. It further affirms, under penalty of perjury, that it remains
eligible for inclusion on the Pro Bono List and will continue to provide such services to respondents appearing before each
immigration court where it has been included on the List. The pro bono referral service will update its contact information or
eligibility status within ten days pursuant to 8 C.F.R. § 1003.66.
Under penalty of perjury, I declare: I am the authorized officer of [PLACE HOLDER FOR PROVIDER NAME]; I have examined this
form, including the affirmations and accompanying attachments, if any; and, to the best of my knowledge and belief, it is true,
correct, and complete.
I have read and understood these statements

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© 2019 U.S. D E PA RT M E N T O F J U ST I C E

Signature of Authorized Officer *

Title of Authorized Officer *

Email *

Phone Number *

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Date *

CONT IN UE

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CO NTACT D OJ

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T H E U N I T E D S TAT E S

HOM E

D E PA RT M E N T O F J U S T I C E

Pro Bono List Application
Pro Bono Referral Service
1

AP P L I CATI ON

FA Q

5. Review

Review Your Application

Application Type

PROVIDER TYPE
2

Review Applicant Information

Pro Bono Referral Service - Renewal Application

3

Pro Bono List Information

APPLICANT INFORMATION

4

Attachments
Declaration

5

Review

Name
Website
Location

----

DECLARATION
Signed by: -Signed on: --

INFORMATION AS IT WILL APPEAR ON THE PRO BONO LIST
** Pro Bono Referral Service

S T A T E | [Name of Immigration Court]

BLANK

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SUB M IT

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