Expungement Interest Form - Columbus Urban League Columbus Urban League

Name:*

First Last

Date of Birth:*

Best Phone Number:*

Alternate Phone Number:

Email:

Aliases, Nicknames, Maiden or Alternative Names

Current Address:*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

How long have you lived at current address?*

If seeking an expungement/sealing of criminal records, please list ALL past convictions you can remember (when a judge found you guilty or you pleaded no contest/guilty):

Please include City/suburb, Year (or approximate year) and offense (also indicate if conviction was in juvenile court)

Are you still on probation or parole for any offense?*

Yes

If yes, which ones?

Do you still owe fines or court costs on any cases?*

Yes

If yes, which ones?

Are you presently living with a partner?*

Yes

If yes, what is their name?

If yes, what is their phone number?

Do you have any children?*

Yes

If so, please list their names and ages:

Are you supporting your children & how?

Are you presently employed?*

Yes

Employer Name:

Job Title:

How Long have you been employed there?

If unemployed, what was your last job?

When did you work there?

What is your level of education?

Highest degree received:

Institution:

Area of Study/Type of Degree:

Do you have any vocational or special training? If so, please explain:

Do you have a military background?*

Yes

If so, please provide details:

Is there any other information you believe we should know or that would help to plead your case?

I give consent for the Columbus Urban League to share my personal information with third-party providers for the expungement process.*

Yes

This field is for validation purposes and should be left unchanged.