Expungement and Employment Barriers Clinic: Application
****PARTICIPATION IN THE CLINIC IS BY APPOINTMENT ONLY****



Please note that NO WALK-INS will be served at the clinic. You MUST receive a letter in the mail with an appointment time.

If you cannot make a clinic, please call Iowa Legal Aid's regular line below and do a regular intake.


If you are having issues filling out this form, please call Iowa Legal Aid at 1-800-532-1275 and tell the receptionist that you want to apply for the Expungement and Employment Barriers Clinic.
Email address *
Thank you for your interest in Iowa Legal Aid's Expungement and Employment Barriers Clinic! This clinic offers assistance with criminal record expungement, license reinstatement, court fees, and background checks.
Please choose the city of the clinic you would like to attend: *
First Name *
Your answer
Last Name *
Your answer
Birthdate *
MM
/
DD
/
YYYY
Last 5 of Social Security Number *
Your answer
Driver's License or Identification Card # *
Your answer
Address *
Your answer
City *
Your answer
State *
Your answer
Zipcode *
Your answer
Phone Number *
Your answer
Alternate Phone Number
Your answer
Race/Ethnicity
Gender
Have you been denied employment or housing because of your criminal record?
Do you currently have difficulty in registering a vehicle or getting a driver’s license because of your criminal record?
Do you currently have issues related to “court debt” (fines, restitution, public defender fees, jail fees, etc.)?
Are you being garnished, threatened with jail if you do not pay, barred from driving or registering a vehicle, having bail or tax refunds offset, etc.?
A copy of your responses will be emailed to the address you provided.
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