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First Name

Last Name

Phone

Country of Origin

Age

Date of Birth

Gender

Date arrived in United States

Alien Number/A# (optional)

Religion

What languages do you speak?

What is your current level of English speaking?

Do you know someone who can translate to English from your language for an interview, if necessary?

Yes

Are you in the US alone?

Yes

Who is with you in your family? (Names, ages, and gender)

How did you hear about DASH?

When are you available to meet with the DASH Coordinator over the next two weeks?

Do you have a valid contract with a lawyer representing their asylum case?

Yes

Do you have a current work permit?

Yes

Have you gotten your work permit within the last 6 months?

Yes

Do you have a valid Texas driver's license?

Yes

Do you have food stamps or WIC?

Yes

Do you need housing?

Yes

Are you willing to share a room?

Yes

Describe your current living situation, and explain why you feel that you need a new place to stay:

Do you have less than $1,000?

Yes

City where you currently live?

If you do not live in Fort Worth are you willing to move here?

Yes

Are you willing to follow all U.S. laws (including not working without a work permit and not driving without a valid Texas driver's license)?

Yes

Are you willing to follow all of the rules of the DASH Covenant & Apartment Rules, including volunteering 15 hours per week, attending events, etc.?

Yes

Click here to view the DASH Covenant & Apartment Rules

Are you willing to sign the DASH Waiver prior to joining DASH Network?

Yes

Click here to view the DASH Waiver & Release Form

Were you referred to immigration court (removal proceedings or defensive hearing)?

Yes

Do you have any documents from U.S. Citizenship & Immigration Services?

Yes

If so, what documentation do you have?

Name of lawyer

Lawyer phone and/or email

Why are you afraid to return to your country?

Please explain in detail (answers must be at least 4 sentences long – All answers are confidential within DASH staff, leaders, and hosts)

*It is the policy of DASH Network not to discriminate against applicants for DASH Network services on the basis of race, color, ancestry, national origin, citizenship, age, sex, gender, sexual orientation, marital status, parental status, membership in any labor organization, political ideology, or disability. DASH Network has adopted an internal grievance procedure providing for prompt and equitable resolution of complaints alleging any action of discrimination.

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