July 21 DACA Clinic Registration/Registración para renovación de DACA Julio 21
Por favor regístrese usando esta forma. Uno de nuestros voluntarios le llamará para confirmar su cita.
***Please sign up using this form. One of our volunteers will contact you to confirm your appointment at our clinic.***

DACA Clinic
Saturday, July 21st 2018
9am - 12pm.
St. Helen Catholic Church
2700 E University Ave, Georgetown, TX 78626

Name of Applicant/ Nombre del Aplicante *
Sign up individual applicants separately/ Registre cada aplicante individualmente
Your answer
Phone Number / Número de Telefono *
Submit best contact number in order for us to call you and remind you of the event/ Ponga el numero mas accesible para ponernos en contacto sobre este evento
Your answer
E-mail Address / Correo Electronico
We can email you resources and future events of our program/ Le podemos mandar recursos y fechas de nuestros eventos
Your answer
Language Preference / Preferencia de Idioma
What is the exact expiration date of your current DACA?/¿Cual es la fecha de vencimiento de su DACA? *
MM
/
DD
/
YYYY
Is your address different than the one you provided when you last renewed your DACA? / ¿Su direccion de domicilio es diferente a la que dio la ultima vez que renovo? *
Have you ever had any encounters with law enforcement (e.g., arrests, charges, convictions, dismissals)? / ¿Ha tenido algún encuentro con la policía o la ley (p.ej., arrestos, cargos, convicciones, casos eliminados)? *
Have you been arrested by ICE or put into removal proceedings? / ¿Ha sido arrestado por ICE o puesto en procedimientos de expulsion? *
How did you hear about our clinic? / ¿Como se enteró de nuestro taller? *
Your answer
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