NON DETAINED

UNITED STATES DEPARTMENT OF JUSTICE

EXECUTIVE OFFICE FOR IMMIGRATION REVIEW

IMMIGRATION COURT

CITY, STATE

In the Matter of: LAST NAME(S), FIRST NAME Respondent. In Removal Proceedings.	FILE NO.: A ###-###-###

Immigration Judge: XXXXXXXXXX	Next Hearing: MM/DD/YYYY at TIME

Hearing Type: XXXXXXXXXX

RESPONDENT’S APPLICATION FOR ASYLUM, WITHHOLDING OF REMOVAL, AND PROTECTION UNDER THE CONVENTION AGAINST TORTURE