Form CFS 1016 Immigration Services Referral Form - Illinois

Form CFS1016 or the "Immigration Services Referral Form" is a form issued by the Illinois Department of Children and Family Services.

Download a PDF version of the Form CFS1016 down below or find it on the Illinois Department of Children and Family Services Forms website.

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CFS 1016
State of Illinois
Rev 6/2017
Department of Children and Family Services
IMMIGRATION SERVICES REFERRAL FORM
FAX COMPLETED FORM TO: DCFS, OFFICE OF THE GUARDIAN, IMMIGRATION SERVICES UNIT (ISU)
at 312-793-3546. ANY QUESTIONS MAY BE DIRECTED TO 312-814-8600.
Type of Immigration Services Requested:
a.
Replacement Documents (specify):
b.
Legal Status Adjustment:
Naturalization
Lawful Permanent Residence (LPR) Status
c.
Other (specify):
(e.g. Deportation hold, consulate intervention, immigration legal assistance)
1.
DCFS Case Name/Case ID #:
2.
Child's Complete Birth Name:
City, State & Country of Birth:
Exact Date of Birth:
Does Minor have a Birth Certificate or Proof of Nationality?
Yes
No
3.
Minor's Country of LAST RESIDENCE Outside of the U.S.:
4.
Name of Biological Mother:
Mother's Place of Birth:
Mother's Last Known Whereabouts:
5.
Name of Biological Father:
Father's Place of Birth:
Father's Last Known Whereabouts:
6.
Date of Minor's First Entry into the U.S:
Has Minor Ever Left the U. S.?
Yes
No
7.
HOW and WHERE did Minor Enter the U.S., if known?
Did Minor Enter with a Passport/Visa?
Yes
No
If yes, Passport/Visa #
Minor’s Legal Status:
A#:
SSN:
8.
WHEN was the DCFS Case Opened?
WHY was the Case Opened?
Neglect
Abuse
Dependency
Other
Date Guardianship was granted in Court:
9a.
Has this youth ever been employed?
Yes
No If yes, when & where?
9b.
Has this youth ever been arrested, charged or detained by police or other law officials for any violation of the law?
Yes
No If yes, when & why?
DCFS & POS Caseworkers are required to personally address these two issues with any youth age 14 and older and
review all case records/files to ensure a correct answer. Attach additional sheet if necessary.
10.
Minor’s Current Foster Care/Substitute Care Placement Address & Telephone #:
11.
Court Docket #:
Calendar:
12.
Case Worker Name & Telephone #:
DCFS Office:
POS Agency/Name:
Region/Site/Field #:
DATE SENT TO IMMIGRATION SERVICES UNIT (ISU):
DATE RECEIVED BY ISU:
CFS 1016
State of Illinois
Rev 6/2017
Department of Children and Family Services
IMMIGRATION SERVICES REFERRAL FORM
FAX COMPLETED FORM TO: DCFS, OFFICE OF THE GUARDIAN, IMMIGRATION SERVICES UNIT (ISU)
at 312-793-3546. ANY QUESTIONS MAY BE DIRECTED TO 312-814-8600.
Type of Immigration Services Requested:
a.
Replacement Documents (specify):
b.
Legal Status Adjustment:
Naturalization
Lawful Permanent Residence (LPR) Status
c.
Other (specify):
(e.g. Deportation hold, consulate intervention, immigration legal assistance)
1.
DCFS Case Name/Case ID #:
2.
Child's Complete Birth Name:
City, State & Country of Birth:
Exact Date of Birth:
Does Minor have a Birth Certificate or Proof of Nationality?
Yes
No
3.
Minor's Country of LAST RESIDENCE Outside of the U.S.:
4.
Name of Biological Mother:
Mother's Place of Birth:
Mother's Last Known Whereabouts:
5.
Name of Biological Father:
Father's Place of Birth:
Father's Last Known Whereabouts:
6.
Date of Minor's First Entry into the U.S:
Has Minor Ever Left the U. S.?
Yes
No
7.
HOW and WHERE did Minor Enter the U.S., if known?
Did Minor Enter with a Passport/Visa?
Yes
No
If yes, Passport/Visa #
Minor’s Legal Status:
A#:
SSN:
8.
WHEN was the DCFS Case Opened?
WHY was the Case Opened?
Neglect
Abuse
Dependency
Other
Date Guardianship was granted in Court:
9a.
Has this youth ever been employed?
Yes
No If yes, when & where?
9b.
Has this youth ever been arrested, charged or detained by police or other law officials for any violation of the law?
Yes
No If yes, when & why?
DCFS & POS Caseworkers are required to personally address these two issues with any youth age 14 and older and
review all case records/files to ensure a correct answer. Attach additional sheet if necessary.
10.
Minor’s Current Foster Care/Substitute Care Placement Address & Telephone #:
11.
Court Docket #:
Calendar:
12.
Case Worker Name & Telephone #:
DCFS Office:
POS Agency/Name:
Region/Site/Field #:
DATE SENT TO IMMIGRATION SERVICES UNIT (ISU):
DATE RECEIVED BY ISU:

Download Form CFS 1016 Immigration Services Referral Form - Illinois

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