Form G-28 - Notice Of Entry Of Appearance As Attorney Or Accredited Representative Page 2

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Part 2. Notice of Appearance as Attorney or
Part 3. Eligibility Information for Attorney or
Accredited Representative (continued)
Accredited Representative
Select all applicable items.
Information About Applicant, Petitioner,
Requestor, or Respondent (continued)
I am an attorney eligible to practice law in, and a
member in good standing of, the bar of the highest
USCIS ELIS Account Number (if any)
courts of the following states, possessions, territories,
commonwealths, or the District of Columbia. (If you
need additional space, use Part 6.)
Alien Registration Number (A-Number) or Receipt Number
Licensing Authority
Daytime Telephone Number
1.b. Bar Number (if applicable)
Mobile Telephone Number (if any)
1.c. Name of Law Firm
E-Mail Address (if any)
1.d. I (choose one)
am not
subject to any order of any court or administrative agency
disbarring, suspending, enjoining, restraining, or otherwise
Mailing Address of Applicant, Petitioner,
restricting me in the practice of law. If you are subject to
Requestor, or Respondent
any orders, explain in the space below. (If you need
NOTE: Provide the mailing address of the applicant, petitioner,
additional space, use Part 6.)
requestor, or respondent. Do not provide the business mailing
address of the attorney or accredited representative unless it
serves as the safe mailing address on the application, petition, or
I am an accredited representative of the following
request being filed with this Form G-28.
qualified nonprofit religious, charitable, social
service, or similar organization established in the
12.a. Street Number
United States, so recognized by the Department of
and Name
Justice, Board of Immigration Appeals, in accordance
12.b. Apt.
with 8 CFR 292.2. Provide the name of the
organization and the expiration date of accreditation.
12.c. City or Town
2.b. Name of Recognized Organization
12.d. State
12.e. ZIP Code
2.c. Date accreditation expires
(mm/dd/yyyy) ►
Postal Code
Form G-28 05/05/16 Y
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