Evacuating Afghanistan

Required fields are followed by *.

Identifying Information (of person seeking to leave Afghanistan)

Prefix:

First Name: *

Middle:

Last Name: *

Age: *

Citizenship: *

Date of Birth: *

Supporting Information (of person seeking to leave Afghanistan)

Current Citizenship Status:

If they were referred to the USRAP, please indicate what government agency or US Media/US NGO referred them:

Connection to the United States (where applicable):

Current location and mobility:

Contact information (including email, messaging abilities, etc.):

services