If you were an au pair on a J-1 visa in the United States between Jan. 1, 2009, and October 28, 2018, you could get a payment from a settlement.

AU PAIR CLASS & COLLECTIVE ACTION

SETTLEMENT CLAIM FORM

In order to receive your portion of the Settlement, you must complete this Claim Form. Please answer the questions to the best of your knowledge and recollection. You do not need to submit any additional documentation at this time. However, the Claims Administrator may reach out to you if they require any additional information to process your claim.

Please read the Notice of Proposed Settlement of Class and Collective Action, Fairness Hearing, and Right to Appear ("Notice"). The Notice is also available here. The Notice, and the Claims Administrator's website, www.aupairclassaction.com, contain more information about your rights and options and may be useful to you in deciding whether to submit this Claim Form.

Completed Claim Forms must be sent to the Claims Administrator either by email as a PDF attachment to info@aupairclassaction.com or by mail to:

Beltran v. InterExchange
c/o JND Legal Administration
P.O. Box 91345
Seattle, WA 98111

YOUR CLAIM FORM MUST BE SUBMITTED ELECTRONICALLY OR POSTMARKED BY MAY 2, 2019.

1. CONTACT INFORMATION

If your name has changed since you began working as an au pair, please also provide your former name(s):

2. AU PAIR PLACEMENTS

Select the sponsor for your first host family placement family from the list below. If you had more than one au pair placement (i.e., more than one host family), select the sponsor for your first host family placement. Click on "+ Add additional placement" below to add information about subsequent placements. If you were re-matched to a host family other than your first, that counts as an additional au pair placement. If you extended your au pair placement with one host family, and were never placed with a second host family, that does not count as an additional au pair placement, but the dates you provided for that placement should reflect the extension.

Placement #1:

Please provide the dates of your host family placement with the au pair sponsor you selected.

In what State did this placement take place?

Were you typically paid a stipend of $195 to $200 per week by your host family during this placement?

3. CERTIFICATION

I certify that the information provided in this form is true and accurate to the best of my knowledge.

If you have read the information available on this website but still have questions, you can contact the class administrator using one of the following methods: