Referral form – Pro Bono

Due to limited resources, we are only able to provide advice and representation on complex British citizenship matters to destitute or low-income young persons. Please fully complete this referral form.

IMPORTANT: Due to the nature of our legal advice and assistance, we are required to keep your data for a certain period.

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Name of Referral Agency and contact details

Young person's details

Full name of young person *

First

Last

Date of birth

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Address of young person

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Phone number

Email address

Age

Country of birth

Nationality

Ethnicity

Date of arrival in the UK (if applicable)

Length of time living in the UK (if applicable)

Dates of any absence(s) from the UK since birth or since first arrival in the UK

Young person’s legal status in the UK

Date of grant of stay in the UK (if applicable)

Any medical/special needs

Details of any fine(s)/caution(s)/criminal conviction(s)

Mother's details

Was the mother married to another man at the time of the child’s birth? *

• Yes
• No
• Not sure

Mother’s nationality

If British citizen, please confirm whether this is by birth, naturalisation or registration *

• Birth
• Naturalisation
• Registration
• Not known

Date of registration or naturalisation

Mother’s status in the UK

Date of grant of status

If ILR/settled, date of grant

Father's details

Father’s nationality

If British citizen, confirm whether this is by birth, naturalisation or registration *

• Birth
• Naturalisation
• Registration
• Not known

Date of registration or naturalisation

Father’s status in the UK

Date of grant of status

If ILR/settled, date of grant

Parents' relationship

Are the child’s parents married to each other? *

• Yes
• No
• Not sure

Date of marriage

Were the child’s parents married at the time of the child’s birth? *

• Yes
• No
• Not sure

Financial circumstances

What is the young person’s or parent(s)/carer’s financial circumstances?

Income *

• Working full time
• Working part time
• State benefits
• Local Authority support
• Destitute
• Not sure

Savings *

• None
• More than £1,000
• More than £5,000
• Not sure

Emergency contact person’s details

Emergency contact person

Contact number

Email address *

Relationship to young person

Additional information

Are there any urgent deadlines?

Any additional information

If possible and relevant, please attach copies of any status document/Home Office citizenship decision or any other relevant documents

Submit