Expungement/Reduction

Your Name*

First NameLast Name

If applicable, please include any former legal name(s) here:

Birth Date*

MonthDayYear

Phone Number*

Format: (000) 000-0000.

E-mail*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

What service are you requesting?*

Who referred you to this service?*

Example: AP&P, USARA, Re-entry Fair, DWS, etc.

Street Address Line 2

Have you ever been incarcerated?*

This includes a book and release. If not, our funding will not be able to provide financial assistance to pay for the expungement. However, we can still go through the process with you.

Do you have any children under the age of 18?*

If not, our funding will not be able to provide financial assistance to pay for the expungement. However, we can still go through the process with you.

Do you have a case with Department of Workforce Services (DWS)?*

This helps determine eligibility for our grant to help pay for the process.

1. Do you have an active or pending criminal case?*

Active or pending criminal case includes a person: still going to court/awaiting a court date, on probation/parole, has active warrants, etc.

2. Do you have any unpaid fines, fees, or restitution?*

Do you owe money to court, a victim, probation services, or the Office of State Debt Collection? If so, please select "Yes".

3. Do you have more than one felony conviction?*

Please account for convictions only. If you have more than one case with a felony conviction, please select "Yes". If you have multiple felony convictions within the same case, please select "No".

4. Have you been convicted of any of the below offenses?*

5. Are you still in the waiting period for your convicted charge?*

This waiting period starts once the case is closed. If found guilty, a case is closed once all conviction requirements are completed. This includes things like probation, treatment, assessments, classes, etc. The waiting period timeframes are listed below.

Did you answer "Yes" to any of the questions 1-5? *

If interested in a reduction, please list the offense(s) and the classification(s) wishing to be reduced. (i.e. Theft, Third Degree Felony)

Additional Comments:

Please include any other information that you feel is applicable.

Consent to Access Records on Xchange: Public Case Search

Please read, date, and type your name below

Terms & Conditions

I hereby agree and give my permission for Cottages of Hope to access my records on Xchange. Xchange is a platform used to search public case information. This information will be used to further access the eligibility of an applicant.

Date

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