Expungement Clinic Registration Form

Please note: eligibility screening takes between 48 - 72 hours to complete. If you have additional questions, please email expungement@clackamasworkforce.org. Walk-In appointments are accepted at our clinics ahead of your screening.

Our expungement clinics aim to help all our community members reduce barriers to employment, housing, and education. We are dedicated to increasing access to justice, education, and career training, by helping those who qualify remove this barrier and help to create a second chance for a better way of life.

Please answer ALL questions to the best of your abilities.

Question Title

1. Which service do you need?

Criminal Record Expungement

Eviction Expungement

DACA Renewals & Immigration Court Assistance (February Clinic)

Legal Name Change

Gender Marker Change

Multiple Services

Describe multiple services required

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2. Legal Name

First

Last

Alias or Previously Used First or Last Name

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3. Date of Birth

Month / Date / Year

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4. Phone Number - please format XXX-XXX-XXXX

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5. Email Address

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6. Address

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

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7. How much total combined money did all members of your household earn in the previous year?

Under $15,000

Between $15,000 and $29,999

Between $30,000 and $49,999

Between $50,000 and $74,999

Between $75,000 and $99,999

Between $100,000 and $150,000

Over $150,000

Prefer not to disclose

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8. Including yourself, how many people currently live in your household?

More than 4

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9. Highest Education Level Completed

Did not complete HS Diploma / GED / Equivalent

High School Diploma / GED

Some College or Postsecondary Training

Postsecondary Training

Associated Degree

Bachelor's Degree or Higher

Unknown

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10. Which of the following best describes your racial or ethnic identity? (click all that apply)

Black/African American

White/Caucasian

Latino/a, non-white

Latino/a, white

Asian/Pacific Islander

Native American/Alaskan Native/Indigenous American

Mixed Race

LGBTQ

Veteran

Person with a Disability

Prefer not to disclose

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11. Any additional information you would like to provide?

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12. Are you interested in learning more about any of the following:

Employment and Job Search Assistance

Housing

Financial Planning / Money Management

Education and Training

Food Assistance

Other (please specify)

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13. How did you hear about this Expungement Clinic?

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14. Do volunteers have your permission to look up your criminal record?

Yes

Expungement Clinic Registration Form

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* 1. Which service do you need?

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* 2. Legal Name

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* 3. Date of Birth

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* 4. Phone Number - please format XXX-XXX-XXXX

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* 5. Email Address

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* 6. Address

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* 7. How much total combined money did all members of your household earn in the previous year?

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* 8. Including yourself, how many people currently live in your household?

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* 9. Highest Education Level Completed

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* 10. Which of the following best describes your racial or ethnic identity? (click all that apply)

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* 11. Any additional information you would like to provide?

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* 12. Are you interested in learning more about any of the following:

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* 13. How did you hear about this Expungement Clinic?

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* 14. Do volunteers have your permission to look up your criminal record?

1. Which service do you need?

2. Legal Name

3. Date of Birth

4. Phone Number - please format XXX-XXX-XXXX

5. Email Address

6. Address

7. How much total combined money did all members of your household earn in the previous year?

8. Including yourself, how many people currently live in your household?

9. Highest Education Level Completed

10. Which of the following best describes your racial or ethnic identity? (click all that apply)

11. Any additional information you would like to provide?

12. Are you interested in learning more about any of the following:

13. How did you hear about this Expungement Clinic?

14. Do volunteers have your permission to look up your criminal record?