WNYCST Forensic Request Evaluation Form - - wnyhrc 2025

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The document is a Forensic Evaluation Request Form from the Western New York Center for Survivors of Torture, designed for attorneys to request evaluations for clients who are survivors of torture. It includes sections for attorney and client information, consent for evaluation, type of application (e.g., asylum, T Visa), evaluation details, and a description of the client's persecution. The form emphasizes confidentiality and the importance of documenting the client's experiences while providing options for language assistance and evaluator preferences.

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Click ‘Get Form’ to open it in the editor.
Begin by filling out the Attorney Contact Information section. Provide your name, agency or firm, address, telephone, fax, and email. If you are a student attorney, include the supervising attorney's name and email.
Next, complete the Client Information section. Ensure you indicate whether your client has consented to the evaluation and provide their age, name, country of origin, and Alien Registration Number.
In the Type of Application section, select the appropriate application type (e.g., Asylum, T Visa) and check all relevant boxes regarding the basis for application.
Proceed to Evaluation Information. Specify the type of evaluation requested and any preferences for evaluators or medical scribes.
Finally, describe the details of your client's case in 4-5 sentences in the provided space. Be sure to include any relevant information about persecution suffered.

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