The Evaluation Network is currently AT CAPACITY and is unable to take on new requests for psychological evaluations. Urgent medical evaluations may be considered on a case by case basis.
Click here for more information about the impact of COVID-19 on our program’s waitlist and services.
If you have any questions, please contact us at email@example.com.
How To Request An Evaluation
The NEW Online Referral Process
In an effort to ensure that all evaluation requests are received and reviewed in an equitable and timely manner, the Evaluation Network has transitioned to a secure electronic referral process.
The previous online request portal was discontinued as of November 15th 2019. Requests sent directly through email, fax, or through the mail will not be considered unless an online referral form is also submitted. We apologize for any inconvenience.
- Applicant’s Identifying Information: legal names, date of birth, country of origin, gender, detention status, client type, A#s, etc.
- Details about your client’s assessment and logistical needs : type(s) of evaluation(s) requested, case type, case status, hearing/interview dates, affidavit deadlines, interpretation needs, testimony needs, special considerations, applicant’s city of residence, applicant’s availability, etc..
- Other Case Details: basis for asylum, specifics to evaluate, additional information about other legal concerns or criminal history.
- Demographic Information (Optional): Providing information about the applicant’s employment , housing, educational history, household size, and potential resource needs.
- Contact Information: Legal representative’s contact information, applicant’s contact information.
Once you have submitted the evaluation request form, please email the following documents to firstname.lastname@example.org:
- A signed release of information (click here to download blank form)**
- A full draft of the applicant’s case declaration**
- Any additional medical & mental health records, police reports, or additional documents that are available, may be relevant for the evaluation.
PLEASE NOTE: We cannot accept referrals without these docx**
If you have any questions, please email our team at email@example.com!