HIAS PA Referral Form for Urgent Cases
HIAS PA is closed for general intake from April 16th to June 1st, 2021. We remain open for intake for the following types of cases: detained cases, victims of domestic violence, immigrant youth, naturalization, victims of crimes, victims of torture, DACA, refugee adjustments, services for asylees, citizenship classes, and Venezuelan TPS. For these services, please call us at 215-832-0900.
Our agency remains open for emergency referrals from service providers only. This form is for nonprofits, hospitals, and other organizations to refer urgent cases for HIAS PA's services. If you are an individual seeking our services, please instead call HIAS PA's intake line at 215-832-0900 when it is open.
What is YOUR name?
What organization are you from?
What is the best number to reach you?
Please briefly describe the nature of your referral. Please DO NOT include any identifying information of the individual.
Never submit passwords through Google Forms.
This form was created inside of Hiaspa.org.