Form G-28 - Notice Of Entry Of Appearance As Attorney Or Accredited Representative Page 3
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4If you do not want to receive original notices or secure
Part 3. Eligibility Information for Attorney or
identity documents directly, but would rather have such
Accredited Representative (continued)
notices and documents sent to your attorney of record or
accredited representative, please select all applicable
3.
I am associated with
boxes below:
,
I request DHS send any notice (including Form I-94)
2.a
the attorney or accredited representative of record
on an application, petition, or request to the U.S.
who previously filed Form G-28 in this case, and my
business address of my attorney of record or
appearance as an attorney or accredited representative
accredited representative as listed in this form. I
is at his or her request.
understand that I may change this election at any
NOTE: If you select this item, also complete Item
future date through written notice to DHS.
Numbers 1.a. - 1.b. or Item Numbers 2.a. - 2.c. in
I request that DHS send any secure identity document,
Part 3. (whichever is appropriate).
2.b.
such as a Permanent Resident Card, Employment
4.a.
I am a law student or law graduate working under the
Authorization Document, or Travel Document, that I am
direct supervision of the attorney or accredited
approved to receive and authorized to possess, to the
representative of record on this form in accordance
U.S. business address of my attorney of record or
with the requirements in 8 CFR 292.1(a)(2)(iv).
accredited representative as listed in this form or to a
designated military or diplomatic address for pickup in a
4.b.
Name of Law Student or Law Graduate
foreign country (if permitted). I consent to having my
secure identity document sent to my attorney of record
or accredited representative's U.S. business address and
understand that I may request, at any future date and
through written notice to DHS, that DHS send any
Part 4. Applicant, Petitioner, Requestor, or
secure identity document to me directly.
Respondent Consent to Representation, Contact
3.a. Signature of Applicant, Petitioner, Requestor, or
Information, and Signature
Respondent
Consent to Representation and Release of Information
3.b. Date of Signature (mm/dd/yyyy)►
I have requested the representation of and consented to
1.
being represented by the attorney or accredited
representative named in Part 1. of this form. According
Part 5. Signature of Attorney or Accredited
to the Privacy Act of 1974 and DHS policy, I also consent
Representative
to the disclosure to the named attorney or accredited
representative of any record pertaining to me that appears
I have read and understand the regulations and conditions
in any system of records of USCIS, ICE or CBP.
contained in 8 CFR 103.2 and 292 governing appearances and
When you (the applicant, petitioner, requestor, or
representation before the Department of Homeland Security.
respondent) are represented, DHS will send notices to both
I declare under penalty of perjury under the laws of the United
you and your attorney or accredited representative either
States that the information I have provided on this form is true
through mail or electronic delivery.
and correct.
DHS will also send the Form I-94, Arrival Departure
1.
Signature of Attorney or Accredited Representative
Record, to you unless you select Item Number 2.a. in
Part 4. All secure identity documents and Travel
Documents will be sent to you (the applicant, petitioner,
2.
Signature of Law Student or Law Graduate
requestor, or respondent) at your U.S. mailing address
unless you ask us to send your secure identity documents
to your attorney of record or accredited representative.
3.
Date of Signature (mm/dd/yyyy)►
Form G-28 05/05/16 Y
Page 3 of 4
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