DHS
Notice of Entry of Appearance
Form G-28
as Attorney or Accredited Representative
OMB No. 1615-0105
Expires 02/29/2016
Department of Homeland Security
Part 1. Information About Attorney or
Part 2. Eligibility Information For Attorney or
Accredited Representative
Accredited Representative
Name and Address of Attorney or Accredited Representative
(Check applicable items(s) below)
1.a. Family Name
I am an attorney eligible to practice law in, and a
1.
(Last Name)
member in good standing of, the bar of the highest
court(s) of the following State(s), possession(s),
1.b. Given Name
territory(ies), commonwealth(s), or the District of
(First Name)
Columbia.
1.c. Middle Name
1.a.
2.
Name of Law Firm or Recognized Organization
1.b. I (choose one)
am not
am
subject to any order of any court or administrative
agency disbarring, suspending, enjoining, restraining,
3.
Name of Law Student or Law Graduate
or otherwise restricting me in the practice of law. (If
you are subject to any order(s), explain fully in the
space below.)
4.
State Bar Number
1.b.1.
5.a.
Street Number
I am an accredited representative of the following
2.
qualified nonprofit religious, charitable, social
Street
5.b.
Name
service, or similar organization established in the
United States, so recognized by the Department of
5.c. Apt.
Ste.
Flr.
Justice, Board of Immigration Appeals pursuant to
8 CFR 292.2. Provide the name of the organization
5.d. City or Town
and the expiration date of accreditation.
2.a. Name of Recognized Organization
5.e. State
5.f.
Zip Code
5.g. Postal Code
2.b. Date Accreditation expires
(mm/dd/yyyy) ►
5.h. Province
5.i.
Country
3.
I am associated with
3.a.
(
)
6.
Daytime Phone Number
-
the attorney or accredited representative of record
who previously filed Form G-28 in this case, and my
7.
E-Mail Address of Attorney or Accredited Representative
appearance as an attorney or accredited representative
is at his or her request. If you check this item, also
complete number 1 (1.a. - 1.b.1.) or number 2 (2.a.
- 2.b.) in Part 2 (whichever is appropriate).
I am a law student or law graduate working under the
4.
direct supervision of the attorney or accredited
representative of record on this form in accordance
with the requirements in 8 CFR 292.1(a)(2)(iv).
Form G-28 02/28/13 N
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