ࡱ>  8bjbj++ r.II/0XB B $P4Q(f(&&&ZZZ'''''''$)i,'ZZZZZ'&&4 ( Z&&' Z' :<%,%&P%h% '!(0Q(r%R-x-%-%ZZ ZZZZZ''`xZZZQ(ZZZZ-ZZZZZZZZZB b:   INCLUDEPICTURE "cid:image001.jpg@01D39AAE.229D2F70" \* MERGEFORMATINET  Kids in Need of Defense UK - PRE-ASSESSMENT QUESTIONNAIRE NOTE TO PEOPLE COMPLETING THIS FORM: MiCLU (based at Islington Law Centre) works as part of Kids in Need of Defense UK to support children and their families to access legal advice in relation to issues that are no longer within the scope of legal aid. At the moment our service is limited to providing advice to children (and their families) who have lived in the UK for 7 years or more and who wish to apply to remain here on that basis. MiCLU does not provide direct advice to individuals in response to this form. We will consider the information on the form, and if we believe that your case is suitable, we will arrange for you to meet with a lawyer acting on a pro bono (free) basis. This form is used by external agencies in order to refer individual children or families to MiCLU for pre-assessment. An adviser or support worker may help you to complete the form. Completing this form does not guarantee that MiCLU or Kids in Need of Defense will take your case on. It just provides us with information that will help us to decide whether your case is one that we will be able to refer to our pro bono partners. If we are able to take your case on we will contact you in order to arrange an appointment with a pro bono lawyer. If demand for our service is high there may be a waiting list. It is therefore important that you provide as much information as possible to enable us to assess the urgency of your case. If you need more space please use additional sheets (please copy and use the last page of this form). Send your completed referral form with all attachments to:  HYPERLINK "mailto:miclu@islingtonlaw.org.uk" \o "miclu@islingtonlaw.org.uk" MiCLU7yearcases@islingtonlaw.org.uk For referring organisations: Please see the notes at the end of this form. DATA PROTECTION: The information provided on this form will remain confidential and will not be shared outside Islington Law Centre (home of MiCLU) and Kids in Need of Defense (including pro bono partners) without your permission. You are entitled to request the information we hold about you under the Data Protection Act 1998. Please contact the organisation you want to obtain information from directly for further details. Section 1 Client contact details Please use name of child who qualifies under 7 year rule and provide details of parent or guardian below. NAME (Child) - Ms/Mrs/Miss/Mr/Master NAME (Parent/Guardian) - Ms/Mrs/Miss/Mr Address Tel. number/s: Email address: (state in brackets if for child or parent/guardian) Nationality: Ethnicity: Do you need an interpreter? Y/N (If yes please state language & dialect:) Disability/Access Needs? Y/N (If yes please provide details:) Section 2 - Immigration and family history Please provide details for yourself and your family members living in the UK. Start with your own name (the child) and details first. Please include all family members in the UK even if they will not be included in your application NameNationalityDate of birthDate of arrival to the UKImmigration status (if any)Relationship to you        If you or any member of your family has previously made any application to remain in the UK, please provide as much information as possible about those applications: Name of person making the applicationType of application madeDate application was submitted to the Home OfficeType of application madeHome Office reference numberOutcome of application     If you have any family members living in your country of origin please provide the following information Name of family memberRelationship to youLocationAge and state of healthAre you in contact with them?      Section 3 Legal representation You (or your family) may have received (or are currently receiving) legal advice for your immigration case. Do you have an immigration lawyer working on your case at the moment? Y/N Did you have an immigration lawyer working on your case in the past? Y/N If you answered yes to any of the questions above please provide the details of the current or previous lawyer(s) involved in your case? Name, address and contact details of Lawyer (including their reference)Dates when they acted for youLegal aid or private paying?Type of application they madeWere all members of your family included in that application?    Section 4 Family/Care details Please provide details of any schools that you/your children have attended: Name of childPrimary School (address, tel no and dates attended)Secondary School (address, tel no and dates attended)College (address, tel no and dates attended)Qualifications obtained (if relevant)     Please provide the name, phone number and surgery address of your GP (if different family members have different GPs please provide all names and addresses): Do you, or any of your family members have any health problems, illnesses or medical conditions? Name of family memberName/description of illnessTreatment received? (Please describe)Medication taken?Hospital or clinic providing treatment or therapy     If you, or any of your family members, (including your children) have spent time in local authority care please provide details: Name of person in careLocal Authority providing careSocial worker's name and contact details (tel; email address)Reasons for being in careDate that left care (if relevant)    Section 5 Further information required If you were not born in the UK, did you have a visa or permission to come to the UK when you first arrived? (please provide dates / details if known) Did you or your family make an application to the Home Office so that you could stay in the UK longer? (please provide copies of the applications made and/or letters you received from the Home Office) Do you know what happened to those applications? Were they granted / refused? Have you been to the immigration court before? Please provide full details: (a) Dates? (b) What happened? Do you have any documents in relation to the above? If so, list these in Section 7 below. Can you explain briefly in your own words why you do not think it would be reasonable to expect your family to return to your country of origin/nationality (please think about whether you have family there, whether you are afraid to return, whether your children would face any particular difficulties): Do you believe that you will be able to pay the fee for making this application or do you want to apply for a fee waiver? Is there anything else you would like the adviser to know? Section 6 Do you have any deadlines? Is the matter urgent? Yes/No Why is it urgent? If you have a particular deadline put this here ././.. Describe reason i.e. court date/time limits etc or tick the box below that applies DESCRIPTIONDATEDESCRIPTIONDATEDate for removal from the UK Court HearingDate to report to immigrationDate for documents to be sent to Home OfficeDate for an interview with the Home OfficeEmployer requires proof of statusCollege/School requires proof of statusLandlord requires proof of statusDoctor requires proof of status Other please specify Social Services housing/support may be terminated Please note that we cannot guarantee that we will be able to take your case on, or arrange for you to be seen within a particular timeframe as our service is dependent upon the availability of volunteer lawyers. If you have an urgent deadline, or a date for removal from the UK this service is unlikely to be appropriate for you. Section 7 - Documents In order to be able to take your case on, our pro bono lawyers will need to see some evidence of your identity where possible. Therefore if you have any documents which are indicated as essential, you must bring one or more of them to your first appointment or it may not be possible for our lawyers to take your case on. Original documents are required where these are available. In order to enable us to provide you with the best possible advice it would be helpful if you could provide us with copies of any documents that you have in relation to the issue you want to discuss. For instance, copies of previous visas issues, applications made or decisions in relation to your applications to enter or remain in the UK. If you do not yet have a copy of your Home Office file we would suggest that you apply for this this whilst you await your appointment. Please provide as much information as possible: Document typeEssential* Copy attached to form (Y/N)Originals available Passport YesNational identity cardYesBirth CertificateYesImmigration Status document(s)Utility billYesPhone bill or bank statementYesLetter from local authority accommodating youYesLetter(s) from legal representativeApplication(s) to the Home OfficeLetter(s) from the Home OfficeLetter(s) from the CourtCourt decision (judgment)Letter(s) from DoctorLetter(s) from College / school / universityOther (please state) *Please note that you do not have to provide all of the documents marked essential, but please provide as many as you do have. Section 8 - ASSESSMENT DETAILS For the use of MiCLU/Kids in Need of Defense: Date and location of 1st pro bono appointment: Pro bono lawyer(s) assigned: Time slot agreed with client: Contact number agreed with client: NOTES FOR REFERRING ORGANISATIONS: This project relies on the services of pro bono lawyers in private practice. As such, we are unable to take on cases in which removal is imminent as we cannot, at present, provide a service to challenge Removal Directions by way of injunction or judicial review. At present the project is only able to provide a pro bono service in relation to applications for children and families who are able to meet the requirements of paragraph 276ADE (1) (iv), also known as the '7 year rule'. Referrals into this project must therefore only be made where there is a reasonable likelihood that the potential clients can meet, or will shortly meet, the requirements of these rules. Referrals of other Article 8 or long residence cases cannot be taken on at this time. We will notify you if our criteria change. Please encourage clients to provide as much information as possible in relation to their current circumstances. Where possible, and safe to do so, we would be grateful if referral organisations would assist clients to obtain a copy of their Home Office file via a Subject Access Request at an early opportunity as this will enable us to make progress in understanding the issues involved, and submitting an application for regularisation as soon as possible. It also minimises time lost during periods when we are operating a waiting list. A copy of this form should also be given to the potential client if they wish. It may help the potential client with understanding what information / documents they need to collate before an advice appointment can be allocated to them. Please do NOT keep any original documents the potential client may have unless you will be attending their first appointment with the pro bono lawyer with them. Please take copies and attach to this pre-assessment questionnaire. The potential client must be advised to bring any original documents with them to the first pro bono appointment. Please note that where a waiting list is in operation the first appointment with the pro bono lawyer may take place some time after this referral sheet is completed, and therefore clients should be reminded to review the information and documents they need to bring with them to their appointment. 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