Response

Passports Form
Privacy Release and Constituent Information Form

*PLEASE NOTE: Do not fill out a Privacy Release on behalf of another constituent unless they are a minor.*

Contact Information

Preferred Prefix

First Name

Middle Name

Last Name

Suffix

Street Address

Street Address (2)

City

State

Zip

Verify Email

Phone

Alternate Phone

Date of Birth

Social Security #

Case Details

Passport Application Number (if known)

*If you can't locate your Passport Application Number, you may find it here after your application has entered processing.

Date you applied for your passport (Date MUST be before, or equal, to today's date. If you have yet to apply, please indicate today's date)

Date of Travel (Departure Date)

Have you paid for expedited processing or overnight shipping of your passport?

The Dept. of State asks that only one Congressional office submit an inquiry on behalf of a constituent.

Have you contacted another Congressional office?

Which Congressional office?

When did you last contact that office?

Is this matter pending before a court of law?

Do other traveling constituents require a passport?

Is this form being filled out on behalf of a minor?

If this constituent is a minor, you may add their application information on this form below. Please add their:

1. Full Name

2. Birthday

3. SSN

4. Application Number

5. Date of Travel if it is different than your own.

6. How they are related to you.

If they are not a minor, please direct them to submit their own form.

Your Request

What do you need help with? (Describe the issue in as much detail as necessary. PLEASE NOTE: If you are filling out this form on behalf of a minor, please describe how you are related to them.)

Is there anything else that Senator Baldwin or her staff needs to know?

Submit and Generate Privacy Release Form

Once you have reviewed your information above, please date, sign, and press the Submit button below to load the confirmation page. This will load a screen where you can verify that your information is correct and make any changes if necessary before submitting a final draft.

Today's Date

Sign using your mouse or finger...