Detained Loved One Form

If your loved one was detained by Immigration in Illinois, please complete this form. You should expect a response within 1-2 business days. Por favor haga clic aquí para ver esta forma en Español.

Your Information

Who will be filling out this form?

First Name

Last Name

Phone Number

Organization Name

Name of Elected Office

Activity Reporting

What happened?

What activity are you reporting?

If "Other", please explain:

Full Legal Name of Detained Individual:

First Name

Last Name

Date of Birth:

Month

Day

Year

Birthday Month Calc

Birthday Day Calc

Birthday Year Calc

Date of Birth

Country of Origin

Most Recent Place of Residence of Detained Individual

City

State

Description of where it happened (Location, Streets or Work Place. Please do not include Home Addresses)

Street Address (Optional)

City (Optional)

State (Optional)

Zip Code (Optional)

What date did this occur?

Month

Day

Year

Activity Month Calc

Activity Day Calc

Activity Year Calc

Activity Date

Notes: