Please share an outline of your story with us. *

Asylum seekers, please contact the Task Force and complete our Intake Form before traveling.

info@lgbtasylum.org | 1-508-853-8853

Name: *

Date of Birth: *

Current Location:

Please upload any evidence that can support your story.

Nationality: *

Are you in a safe location? *

Yes

Do you have a US visa? *

Yes

Please upload any evidence that can support your story.

What is your current housing situation? How much longer can you stay there?

Upload a copy of your passport if available.

How did you hear about us?

Intake Application Form

Email: *

Phone: