Chaldean Federation of America

Chaldean Federation of America
Refugee Sponsorship Form

Dear Members of the Community:

As you know, the CFA has been working to rescue, relieve and resettle our people who have fled the intolerable conditions in the Iraqi homeland. We have been advised by the United States Department of State and the United Nations High Commission for Refugees that the information you complete must be clear, accurate and truthful. Your complete cooperation in filling out the attached application on behalf of your refugee family members will ensure their relief and speed the process of resettlement and family reunification.

Please read the following information carefully; it is the official statement of the United States of America’s policy on refugees.

“In order to be approved as a refugee, the person must establish that he or she has:

suffered past persecution; or,
has a well-founded fear of future persecution because of:

race,
religion,
nationality,
membership in a particular social group, or political opinion, as specified in INA§101(A) (42).

A person, who has ordered, incited, assisted or otherwise participated in persecution on account of race, religion, nationality, membership in a particular social group, or political opinion is, by definition, not a refugee. Likewise, an applicant who has been “firmly resettled” in a third country may not be admitted under INA § 207, and applicants are subject to various statutory grounds of inadmissibility, including criminal, security, and public health grounds, some of which may be waived.”

We are confident that with your cooperation, and our community’s generous contributions of time and effort, we will succeed in bringing your family members to their new home and the beginnings of a new life.

May God bless you all, and may He continue to protect our refugee members and lead them to safety.

Sincerely,

Michael George,

CFA Chairma

Part A: Refugee Sponsor Information 1. Full Name
2. Date of Birth (MM/DD/YYYY)
3. Street Address
Street Address Line 2 (Optional)
City/ZIP
4. Phone # (home)
Phone # (cell)
Phone # (work)
5. Email Address (you@provider.com)
6. Your Immigration Status in the United States	US Citizen Permanent Resident (Green Card) Asylee Refugee Other
If Green Card, Please Enter Green Card #
If You Checked "Other", Please Explain
Part B: Refugee Information 7. Full Name of Refugee Head of Household
8. Date of Birth (MM/DD/YYYY)
9. Gender	Male Female
10. Relationship of Refugee to You
11. Place of Birth (Please provide complete information, including village or city name, province, and country)
12. Complete Current Address in Country of Refuge
13. Current Phone # in Country of Refuge
14. List the names, genders, dates of birth of spouse and all minor children who are immediate family of the refugee named in Item # 7 of this application and complete all requested information:
15. When did the refugee(s) arrive in his/her/their current location? Please provide Month and Year of their arrival in the country of refuge. (MM/YYYY)
16. What language(s) can your relative(s) speak, read and/or write? (Please list relatives)
17. How, or by what method of transportation did he/she/they flee from Iraq?
18. Name of Church, if any, they attended in Iraq.
19. Check all official documents that the refugee(s) are carrying with them:	Iraqi Passport Military Service ID Personal ID Driver’s License Birth Certificate Baptismal Certificate Business Property Ownership Any Other Document(s)
Please list any other official documents that the refugee(s) may have in their possession:
Part C: Refugee(s) Reason(s) for Leaving Iraq: 20. Were the properties of the refugee(s) that you listed on this application subjected to any of the following? (Please check all that apply)	Seizure of business Property confiscation Looting, destruction, and burning of property Prevented from conducting business Forced eviction Property confiscation
21. Were any of the refugees or members of the refugee family that you listed on this application victim(s) of any of the following acts? (Check all that apply)	Physical violence Verbal or written threats of violence Kidnapping Sexual assault ⁭Rape Attempted murder Mutilation Killing / Murder
22. Does (do) the refugee(s) listed on this application believe that he/she/they experienced personal violence or the loss/destruction of their business(es), and/or residence(s) listed in Items 20 and 21 because of (Check all that apply):	Religion Political Affiliation Cooperation/Collaboration with Coalition Forces Other (Please explain below.)
Other:
23. Was/Were the refugee(s) listed on this application prevented from participating in any of their religious practices?	Yes No
If Yes, Please Describe
24. Was/Were any of the refugee(s) listed on this application forced to: (Check all that apply)	Follow strict Islamic Sharia rules Forced to convert to Islam Other
If Other, Please Explain
25. Were any of the refugees listed in this application prevented from exercising freedom of choice in: (Check all that apply.)	⁭Affiliation with a Political Party or Organization Voting Exercising their civil rights
26. Additional Information
Part D: Life in the Country of Refugee 27. Has the refugee applied for and/or been interviewed as a refugee applicant for protection and resettlement with a humanitarian aid organization or agencies such as UNHCR (United Nations)?	Yes No
If the answer is Yes, kindly provide:(a) Name of Agency to which they have applied
(b)Date of Application: (MM/DD/YYYY)
(c) Place in which application was made (country and city):
(d) Status of application for protection, assistance and/or resettlement:	Pending Granted Denied
File Number:
28. Has (Have) the refugee(s) been threatened and /or prevented from applying for protection and resettlement in the country of transit (in their current location)?	Yes No
29. Is this refugee and/or his/her family members allowed to work in the country of refuge? Please check the appropriate response:	Yes No
If able to work, describe the type of occupation in which the refugee(s) is/are engaged.
If not allowed to work, provide reasons why.
Is the refugee and/or family obliged to pay overstay penalty or under threat of deportation in the country of transit?	Yes No
30. Are the children allowed to be enrolled in schools in the country of refuge?	Yes No
31. Does the refugee/family have adequate, sanitary, safe housing?	Yes No
32. Does the refugee/family have access to adequate medical care in the country of refuge	Yes No
KINDLY COMPLETE THIS SUPPLEMENTAL INFORMATION FORM 1. Your Name:
2. Address
City
Zip Code
3. Home Phone (with area code)
4. Work Phone
5. Mobile Phone
6. Email Address (example: you@host.com)
7. Status under which you were admitted to the U.S. Check one box only.	Immigrant Refugee Visitor Asylee Business Visa Student Other
8. Your current status? Check one box only.	Citizen Permanent Resident Visitor Student Work Visa Medical Visa Asylee Applicant In Deportation Proceedings Other
9. PLEASE ANSWER ALL OF THE FOLLOWING (QUESTIONS ON BEHALF OF YOUR REFUGEE APPLICANT) Refugee Name: (Last, First, Middle Initial)
10. Relationship of refugee to you
11. Total # of refugees in this family
12. Complete Address of Refugee
13. Country of Refugee
14. Home Phone
15. Mobile Phone
16. UN number (if registered with UNHCR)
17. Country of desired destination. Please indicate the refugee’s order of preference. A:
B:
C:
DISCLAIMER : This application is being used for information purposes to assist the refugees’ efforts to resettle into a county of permanent residency. The information on this Refugee Sponsorship Form has been furnished by the sponsor and/or refugee applicant