Touchpoints

Javascript is required for this form to function properly.
Javascript does not appear to be enabled.

Provide the following information about why you are asking for the Civil Rights Division’s support, and the Civil Rights Division matter your request for deferred action to DHS is based on. Don’t include 1) your immigration status or immigration history; or 2) sensitive personally identifiable information, such as your birth date, Social Security number, USCIS/A number, or Individual Taxpayer Identification Number (ITIN):

A red asterisk (*) indicates a required field.

Name of the person we should contact (the person asking for the Civil Rights Division’s support or their representative) *

First and last name

Contact information (phone number, email address) *

The Civil Rights Division Section handling the matter your request for deferred action relates to (Appellate, Criminal, Disability Rights, Educational Opportunities, Employment, Federal Coordination and Compliance, Housing and Civil Enforcement, Immigrant and Employee Rights, Special Litigation, Voting Rights. You can note you don’t know, if you aren’t sure which section is handling the matter) *

Explanation of your interest in the Civil Rights Division supporting your request for deferred action to DHS *

Privacy Act Statement for Design Research

Thank you

Error