SEMCA Michigan Works! Clean Slate Application

By accessing this application form, you agree to be bound by the website’s terms and conditions. You also agree to be contacted via email, phone, or text by our staff.

This application form requires you to provide certain information (name, home address, valid email address, etc.) to allow us to retrieve your Internet Criminal History Access Tool (ICHAT) and assess your eligibility for expungement.

You must be 18 years or older to use and/or complete this form. Your information will be kept confidential and will not be shared with third parties, other than those who assist us in operating our website, conducting our business, or servicing you, as long as those parties agree to keep this information confidential.

You MUST enter a valid email address. If you do not have an email address, you may obtain one for free at www.gmail.com or www.yahoo.com.

Email Address (Required to check case status and receive updates)

example@example.com

How did you hear about the SEMCA Clean Slate program?

If selected other, please tell us how you heard about the SEMCA Clean Slate program?

To be eligible for SEMCA Clean Slate, you MUST be a current Monroe County resident. You must upload photos of the front AND back of your State ID, or driver's license.

IF YOU ARE A CURRENT RESIDENT OF WAYNE COUNTY, PLEASE USE BELOW LINK TO REGISTER.

Wayne County Residents Click Here

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

First Name - To find your record, we need to know your name AT THE TIME OF CONVICTION*

First_Name

Last Name - To find your record, we need to know your name AT THE TIME OF CONVICTION*

last_name

Date of Birth (MM-DD-YYYY)*

Date

Race - Race is required by the Michigan State Police to access your criminal record (ICHAT)*

Gender at Birth*

FemaleMale

Phone Number*

Please enter a valid phone number.

Are you currently Married?

YesNo

Annual Household Income*

Please enter your average household yearly income

Are you receiving Cash Assistance?

YesNo

Are you currently on Medicaid?

YesNo

Are you receiving Unemployment?

YesNo

Are you receiving MRS (Michigan Rehabilitation Services?

YesNo

Driver's License Endorsement - Do you have a Chauffeur or Commercial Driver's License?*

NoYes

What convictions do you think may be on your criminal history record? Please list convictions, date (month/year), and what city you were arrested in.

Do you have any of these types of convictions?

- Out of State - We CANNOT expunge out of state convictions but need to know about them to properly determine your eligibility.

- Federal/US District Court - Federal convictions CANNOT be expunged, but we need to know about them to properly determine your eligibility.

- Deferred or sealed convictions (ie. HYTA, 7411, etc.)

(Check all that apply)*

How has/have your conviction(s) prevented you from seeking employment and or education and training?*

Please upload photos of the front AND back of your driver's license, or state ID. Your ID is required so we can verify your identity and residency. Your photo ID must contain a Monroe or Wayne County address.*

Application Status

PendingApprovedDenied

Denial Reason (Pick One)

Reason for Being {Application Status}

Current status of applicaiton for {lastName}:

{applicationStatus}

Reason for Denial: {denialReason}

Additional Information: {reasonFor23}

CS Email

example@example.com

Account ID

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