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INTAKE FORM: ASU Indian Legal Clinic Rights Restoration & Criminal Records
Please take 5-10 minutes to give us some information that will allow our Student-Attorneys to research your case and advise you of your options
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Email
*
Your email
Client Name
*
Your answer
Tribal Affiliation
*
Your answer
Please list any other names you have used (pre-marriage, aliases, etc.)
*
I have not used other names
Other:
Date of Birth
*
MM
/
DD
/
YYYY
Mailing Address
*
Your answer
Phone number
*
Your answer
Name of Person Assisting (translator, etc.)
Your answer
Contact for Person Assisting (translator, etc.)
Your answer
Have You Ever Received a Prison Sentence?
*
Yes - in Arizona state prison
Yes - in another state
Yes - in federal prison
No
Other:
Have you ever been convicted of
a felony
by a
state court
in
Arizona
?
*
Choose
Yes
No
Not Sure
Please list all counties where you have felony convictions (it's okay to leave this blank if you are not sure or do not remember)
Your answer
Have you ever been convicted of
a felony
by a
state court
in
another state
?
*
Choose
Yes
No
Not Sure
Have you ever been convicted of
a felony
by a
federal court
(
in any state
)?
*
Choose
Yes
No
Not Sure
Please list all states other than Arizona where you have felony convictions (including federal)
Your answer
Have You Completed Probation on All Charges?
*
Yes
No
Completed probation on some charges, but not others
Do You Owe Victim Restitution in Any Case?
*
Yes
No
Not Sure
If there were any victim(s) in any of your cases, please list their names, to the best of your knowledge
*
no victims
Other:
Do You Have Marijuana Convictions in Arizona?
*
Yes
No
Not Sure
Do you know of Open Cases or Active Warrants against you?
*
Yes
No
Not Sure
I agree to allow a Student-Attorney to research my cases(s) and to prepare court documents to be reviewed with me and filed on my behalf, for restoration of rights, set aside, expungement, and/or sealing of records, as I may be eligible.
I understand that completing this form does not create an attorney-client relationship. I understand that the Indian Legal Clinic (ILC) will review my case to determine if it can represent me, and if the ILC agrees to represent me, the ILC will prepare a representation agreement.
*
Yes
No
Send me a copy of my responses.
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