Molalla & Sandy 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.

Molalla Expungement Clinic on April 8, 2023 from 12pm - 6pm.

213 N Molalla Ave. Molalla OR 97038

Sandy Expungement Clinic on May 13, 2023 from 12pm - 6pm

39140 Proctor Blvd, Sandy Oregon 97055

Question Title

* 1. Which service do you need? (please check all that apply)

Criminal Record Expungement

Eviction Expungement

DACA Renewals & Immigration Court Assistance

Legal Name & Gender-Marker Changes

Youth Expungement

Other (please specify)

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* 2. Which clinic are you interest in attending?

Molalla - April 8, 2023

Sandy - May 13, 2023

Other (please specify)

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* 3. Legal Name

First

Last

Alias or Previously Used First or Last Name

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* 4. Date of Birth

Month

Date

Year

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* 5. Phone Number

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* 6. Email Address

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* 7. Address

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

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

More than 4

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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

Prefer to describe

Other (please specify) / Prefer to describe

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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