Transfer on Death Deed Clinic Registration Transfer on Death Deed Clinic Registration In partnership with Habitat for Humanity of Omaha Step 1 of 3 33% Section BreakLegal Aid of Nebraska will use the information you provide to see if you qualify for services. However, completing the application does NOT mean Legal Aid of Nebraska will accept your case or that you are a client of Legal AId of Nebraska. Legal Aid of Nebraska cannot represent everyone who applies for help. If you are using a computer that does not belong to you, remember to close out of the browser completely to protect your private information. You must have an email address and phone number to use this online application. If you do not, contact one of our hotlines. https://www.legalaidofnebraska.org/how-we-help/call-for-help/ If you do not hear back from us, it is yoiur responsibility to contact us. Citizenship StatusI am a ...(Required) US Citizen Non-Citizen Are you legally residing in the United States?(Required) Yes No What is your immigration status?(Required)Lawful Permanent ResidentAsylee (application granted or pending)Conditional Entrant (refugee prior to 1980, application must be granted)Conditional Resident (married to US Citizen less than 2 years)Family Unity (spouse or parent was granted amnesty)International Child Abductee (Hague Convention)K Visa (for spouse or children of US Citizen)Granted Withholding of Removal or DeportationRefugee (application must be granted)Registry (continuous resident since 1/1/72)Temporary Agricultural Workers (H2A or H2B forestry work only with related caseT Visa (initial application or application granted/pending, with immigration case)US National (persons born in American Somoa or Commonwealth of Northern Marina IslandsU Visa (with related case)V Visa (temporary visa for spouse and minor children of LPR pending immigration)None of the aboveWhat is your Visa number? When does your Visa expire? Month Day Year What is your green card number? Unfortunately, if you are not a citizen or legal permanent resident, we cannot help you. You may be able to find an attorney through the Nebraska Find-a-Lawyer service, or have a question answered through the ABA Nebraska Free Legal Answers service. The addresses for the websites for these services are: https://www.nefindalawyer.com/ https://ne.freelegalanswers.org// How did you hear about this clinic?(Required) What is your name?First Name(Required) Middle Initial Last Name(Required) Suffix (e.g. Jr., Sr., III) Have you gone by any other names, such as a given-name or former name?(Required) Yes No Enter up to 3 other names you have used:Other Name(Required) Other Name Other Name Date of Birth(Required) Month Day Year Social Security Number(Required) AddressProvide the address where you live. If you are homeless, provide an address where you spend most of your time.(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Is this a safe address to receive mail?(Required) Yes No Do you need to add an address that is safe?(Required) Yes No If yes, list the safe address.Safe Mailing Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code How can we reach you?Email(Required) Phone(Required)May we text you on this phone?(Required) Yes No Do you need a safe phone number?(Required) Yes No If yes, please list the safe number.Second Safe Phone Number(Required)May we text you on this phone?(Required) Yes No Personal InformationGender(Required)FemaleMaleOtherPrefer not to answerWhich pronouns do you use?(Required)He/Him/HisShe/Her/HersThey/Them/TheirsOtherRace/Ethnicity(Required)WhiteHispanic, Latino, or SpanishBlack or African AmericanAsianAmerican Indian or Alaska NativeMiddle Eastern or North AfricanNative Hawaiian or Other Pacific IslanderSome other Race, Ethnicity, or OriginTwo or more racesPrefer Not to AnswerAre you enrolled in a Native American tribe?(Required) Yes No Please select the Native American tribe you are enrolled in(Required)SanteeOmahaWinnebagoPoncaOtherAre you eligible for enrollment in a Native American tribe?(Required) Yes No Please select the Native American tribe you are eligible for enrollment in(Required)SanteeOmahaWinnebagoPoncaOther(First, MI, Last) Gender DOB Enrolled or eligible for enrollment in Native American Tribe?(Required) Do you need an interpreter?(Required) Yes No What language?(Required)AlbanianCambodianCreoleSomaliEnglishFrenchGermanSign LanguageItalianJapaneseHmongMandarinNative AmericanArabicRussianSpanishTurkishVietnameseSerbianCantoneseYiddishNuerDinkaNubianKarenPolishOtherHave you ever served in the military, including the Reserves, National Guard, Army, Navy, Air Force, Marines, or Coast Guard?(Required) Yes No Has anyone in your household ever served in the military?(Required) Yes No Are you disabled?(Required) Yes No Is your disability due to a cognitive impairment? (problems with memory, or understanding)(Required) Yes No Do you have a physical disability?(Required) Yes No What is your marital status?(Required)SingleMarriedDivorcedWidowedLegally SeparatedDomestic partnerHousehold Size Count yourself Count everyone in your household that you are responsibile for and anyone that is responsible for you even if you are not related. Count your partner if you are married or if you have a child together, unless that person is harming you. Count your minor children (under 19 years of age) if they have never lived on their own, or if they have moved back into your home with an intent to stay permanently. Do not count an adult child who has lived independently, but moved back to the home with the intent of it being a temporary living arrangement. Do not count an adult living in the household because of a disability or need for regular care. Do not count the abuser in your household if you are a victim of domestic violence. Do not count roommates.How many adults aged 19 or over?(Required)Please enter a number greater than or equal to 0.How many children live in the house full time?(Required)Please enter a number greater than or equal to 0.Household IncomeWe need information about your household income. For household income, you need to provide the gross income amount, which is the amount before taxes are taken out, for every person you count in your household. Household Employment IncomeDo you or anyone in your household have income from employment ?(Required) Yes No Hours per week(Required)Please enter a number greater than or equal to 0.Wages per hour(Required)Please enter a number greater than or equal to 0.Do you or anyone in your household have other employment?(Required) Yes No Hours per week(Required)Please enter a number greater than or equal to 0.Wages per hour(Required)Please enter a number greater than or equal to 0.Do you or anyone in your household have other employment?(Required) Yes No Hours per week(Required)Please enter a number greater than or equal to 0.Wages per hour(Required)Please enter a number greater than or equal to 0.Other Household IncomeDo you or any members of your household have income from other sources?(Required) Yes No Examples of income from other sources include benefits like SSI, SSDI, Social Security Retirement and income you receive from any source other than from working, such as child support or alimony.Type of income(Required)UnemploymentChild SupportTANF/ADCSSDISSISocial Security RetirementVeteran's benefitsStudent LoansPensionother income typeHow often is this income received?(Required) every week every two weeks once per month annually How much is received?(Required)Please enter a number greater than or equal to 0.Do you or a member of your household have income from additional sources?(Required) Yes No Type of income(Required)UnemploymentChild SupportTANF/ADCSSDISSISocial Security RetirementVeteran's benefitsStudent LoansPensionother income typeHow often is this income received?(Required) every week every two weeks once per month annually How much is received?(Required)Please enter a number greater than or equal to 0.Do you or a member of your household have income from additional sources?(Required) Yes No Type of income(Required)UnemploymentChild SupportTANF/ADCSSDISSISocial Security RetirementVeterans BenefitsStudent LoansPensionOther Income typeHow often is this income received?(Required) every week every two weeks once per month annually How much is received?(Required)Please enter a number greater than or equal to 0.Do you expect your income to change within the next 90 days?(Required) Yes No Household Asset InformationWe need information about the property you own. Provide the total amount of each asset category for EVERY person you counted in your household. Personal Property (enter 0 if none)(Required)Please enter a number greater than or equal to 0.What is the garage sale value of your personal posessions? Do you have any vehicles you do not use for transportation to work or school?(Required) Yes No If yes, list the value of the vehicle(s).Vehicles(Required)What is the value of any vehicles you do not use for transportation to work or school, such as RVs, classic cars, or boats?Do you own any real estate?(Required) Yes No If yes, list the value of that propertyReal Estate(Required)If you own any real estate, not including the home you live in, list the value of that property.Do you have a retirement account such as an IRA/401k/403b?(Required) Yes No If yes, How much money do you have in your retirement accounts? Retirement Accounts(Required)How much money do you have in IRA/401k/403b or other retirement accounts?Do you have a checking account?(Required) Yes No If yes, how much money do you have in your checking account?Checking Account(Required)How much money do you have in checking accounts?Do you have a savings account?(Required) Yes No Savings Account(Required)How much money do you have in savings accounts?Household ExpensesList only those expenses paid by the people you included in your household.Do you or any members of your household have any expenses?(Required) Yes No Examples of expenses include rent, a car payment, daycare, etc. Type of Expense(Required)mortgage or rent paymentcar paymentschild support paidgarnishmentsunreimbursed medical expensesAmount?(Required)Please enter a number greater than or equal to 0.How often do you pay this expense?(Required)every weekevery 2 weeksonce per monthannuallyDo you have other expenses?(Required)YesNoType of Expense(Required)mortgage or rent paymentcar paymentschild support paidgarnishmentsunreimbursed medical expensesAmount?(Required)Please enter a number greater than or equal to 0.How often do you pay this expense?(Required)every weekevery 2 weeksonce per monthannuallyHousingWhat is your housing situation?(Required) Rent Own Homeless Other Are you at risk of losing your housing?(Required) Yes No Is your housing at risk because of your mortgage?(Required) Yes No Which of the following best describes your rental situation? I have a private landlord and receive no ongoing rental assistance I live in a public housing facility owned by a local Housing Authority a housing voucher, Section 8, or live in a rent subsidized building I receive other rental assistance, such as General Assistance. Which of the following best describes your home? Single Family Home Mobile Home that I own Condo, Townhome, duplex, triplex Which of the following best describes your homelessness. I am living in a shelter facility for people experiencing homelessness or domestic violence. I am homeless, but have found other living arrangements, such as living with friends, or in my car? Which of the following best describes your housing situation? I am incarcerated in jail or prison I am living in a nursing home, assisted living facility, or other long-term care facility I am in a hospital Other AbuseAre you a victim of abuse (physical, emotional, mental, human trafficking, etc .)?(Required) Yes No Are you a victim of sexual assault?(Required) Yes No Are you a victim of domestic abuse?(Required) Yes No Are you a victim of stalking(Required) Yes No Are you a victim of human trafficking?(Required) Yes No What is your relationship with the person who abused you ?(Required)Spouse (current or former)Intimate Partner (current or former)Other Family or Household Member (sibling, grandparent, etc.)Acquaintance (friend, neighbor, co-worker, schoolmate, etc.)Dating RelationshipStrangerUnknownSurveysWe sometimes send satisfaction surveys by email or text. Is it ok if we send you a survey?(Required) I would prefer an emailed survey link I would prefer a text message with a survey link I would prefer not to be surveyed by either text or email If you do not wish to receive a survey, please indicate why not(Required) I don't have access to technology I prefer surveys on paper other HiddenCase InformationHiddenHave you had any criminal charges or convictions in the last two years?(Required) Yes No Criminal charges includes (but is not limited to) traffic offenses, such as speeding tickets, driving under suspension, etc.Note: A criminal charge in the last 2 years MAY exclude you from being able to get a case set aside.HiddenWhat cases do you want to set aside or seal?(Required)HiddenIn what year(s) did these charges or convictions happen? If you do not know the exact year, please estimate the year(s) approximately and list below.(Required) Important: You will receive a call from Legal Aid to confirm your registration. You are not fully registered until you have made an appointment with Legal Aid staff. Δ Transfer on Death Deed Clinic Registration In partnership with Habitat for Humanity of Omaha Step 1 of 3 33% Section BreakLegal Aid of Nebraska will use the information you provide to see if you qualify for services. However, completing the application does NOT mean Legal Aid of Nebraska will accept your case or that you are a client of Legal AId of Nebraska. Legal Aid of Nebraska cannot represent everyone who applies for help. If you are using a computer that does not belong to you, remember to close out of the browser completely to protect your private information. You must have an email address and phone number to use this online application. If you do not, contact one of our hotlines. https://www.legalaidofnebraska.org/how-we-help/call-for-help/ If you do not hear back from us, it is yoiur responsibility to contact us. Citizenship StatusI am a …(Required) US Citizen Non-Citizen Are you legally residing in the United States?(Required) Yes No What is your immigration status?(Required)Lawful Permanent ResidentAsylee (application granted or pending)Conditional Entrant (refugee prior to 1980, application must be granted)Conditional Resident (married to US Citizen less than 2 years)Family Unity (spouse or parent was granted amnesty)International Child Abductee (Hague Convention)K Visa (for spouse or children of US Citizen)Granted Withholding of Removal or DeportationRefugee (application must be granted)Registry (continuous resident since 1/1/72)Temporary Agricultural Workers (H2A or H2B forestry work only with related caseT Visa (initial application or application granted/pending, with immigration case)US National (persons born in American Somoa or Commonwealth of Northern Marina IslandsU Visa (with related case)V Visa (temporary visa for spouse and minor children of LPR pending immigration)None of the aboveWhat is your Visa number? When does your Visa expire? Month Day Year What is your green card number? Unfortunately, if you are not a citizen or legal permanent resident, we cannot help you. You may be able to find an attorney through the Nebraska Find-a-Lawyer service, or have a question answered through the ABA Nebraska Free Legal Answers service. The addresses for the websites for these services are: https://www.nefindalawyer.com/ https://ne.freelegalanswers.org// How did you hear about this clinic?(Required) What is your name?First Name(Required) Middle Initial Last Name(Required) Suffix (e.g. Jr., Sr., III) Have you gone by any other names, such as a given-name or former name?(Required) Yes No Enter up to 3 other names you have used:Other Name(Required) Other Name Other Name Date of Birth(Required) Month Day Year Social Security Number(Required) AddressProvide the address where you live. If you are homeless, provide an address where you spend most of your time.(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Is this a safe address to receive mail?(Required) Yes No Do you need to add an address that is safe?(Required) Yes No If yes, list the safe address.Safe Mailing Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code How can we reach you?Email(Required) Phone(Required)May we text you on this phone?(Required) Yes No Do you need a safe phone number?(Required) Yes No If yes, please list the safe number.Second Safe Phone Number(Required)May we text you on this phone?(Required) Yes No Personal InformationGender(Required)FemaleMaleOtherPrefer not to answerWhich pronouns do you use?(Required)He/Him/HisShe/Her/HersThey/Them/TheirsOtherRace/Ethnicity(Required)WhiteHispanic, Latino, or SpanishBlack or African AmericanAsianAmerican Indian or Alaska NativeMiddle Eastern or North AfricanNative Hawaiian or Other Pacific IslanderSome other Race, Ethnicity, or OriginTwo or more racesPrefer Not to AnswerAre you enrolled in a Native American tribe?(Required) Yes No Please select the Native American tribe you are enrolled in(Required)SanteeOmahaWinnebagoPoncaOtherAre you eligible for enrollment in a Native American tribe?(Required) Yes No Please select the Native American tribe you are eligible for enrollment in(Required)SanteeOmahaWinnebagoPoncaOther(First, MI, Last) Gender DOB Enrolled or eligible for enrollment in Native American Tribe?(Required) Do you need an interpreter?(Required) Yes No What language?(Required)AlbanianCambodianCreoleSomaliEnglishFrenchGermanSign LanguageItalianJapaneseHmongMandarinNative AmericanArabicRussianSpanishTurkishVietnameseSerbianCantoneseYiddishNuerDinkaNubianKarenPolishOtherHave you ever served in the military, including the Reserves, National Guard, Army, Navy, Air Force, Marines, or Coast Guard?(Required) Yes No Has anyone in your household ever served in the military?(Required) Yes No Are you disabled?(Required) Yes No Is your disability due to a cognitive impairment? (problems with memory, or understanding)(Required) Yes No Do you have a physical disability?(Required) Yes No What is your marital status?(Required)SingleMarriedDivorcedWidowedLegally SeparatedDomestic partnerHousehold Size Count yourself Count everyone in your household that you are responsibile for and anyone that is responsible for you even if you are not related. Count your partner if you are married or if you have a child together, unless that person is harming you. Count your minor children (under 19 years of age) if they have never lived on their own, or if they have moved back into your home with an intent to stay permanently. Do not count an adult child who has lived independently, but moved back to the home with the intent of it being a temporary living arrangement. Do not count an adult living in the household because of a disability or need for regular care. Do not count the abuser in your household if you are a victim of domestic violence. Do not count roommates.How many adults aged 19 or over?(Required)Please enter a number greater than or equal to 0.How many children live in the house full time?(Required)Please enter a number greater than or equal to 0.Household IncomeWe need information about your household income. For household income, you need to provide the gross income amount, which is the amount before taxes are taken out, for every person you count in your household. Household Employment IncomeDo you or anyone in your household have income from employment ?(Required) Yes No Hours per week(Required)Please enter a number greater than or equal to 0.Wages per hour(Required)Please enter a number greater than or equal to 0.Do you or anyone in your household have other employment?(Required) Yes No Hours per week(Required)Please enter a number greater than or equal to 0.Wages per hour(Required)Please enter a number greater than or equal to 0.Do you or anyone in your household have other employment?(Required) Yes No Hours per week(Required)Please enter a number greater than or equal to 0.Wages per hour(Required)Please enter a number greater than or equal to 0.Other Household IncomeDo you or any members of your household have income from other sources?(Required) Yes No Examples of income from other sources include benefits like SSI, SSDI, Social Security Retirement and income you receive from any source other than from working, such as child support or alimony.Type of income(Required)UnemploymentChild SupportTANF/ADCSSDISSISocial Security RetirementVeteran's benefitsStudent LoansPensionother income typeHow often is this income received?(Required) every week every two weeks once per month annually How much is received?(Required)Please enter a number greater than or equal to 0.Do you or a member of your household have income from additional sources?(Required) Yes No Type of income(Required)UnemploymentChild SupportTANF/ADCSSDISSISocial Security RetirementVeteran's benefitsStudent LoansPensionother income typeHow often is this income received?(Required) every week every two weeks once per month annually How much is received?(Required)Please enter a number greater than or equal to 0.Do you or a member of your household have income from additional sources?(Required) Yes No Type of income(Required)UnemploymentChild SupportTANF/ADCSSDISSISocial Security RetirementVeterans BenefitsStudent LoansPensionOther Income typeHow often is this income received?(Required) every week every two weeks once per month annually How much is received?(Required)Please enter a number greater than or equal to 0.Do you expect your income to change within the next 90 days?(Required) Yes No Household Asset InformationWe need information about the property you own. Provide the total amount of each asset category for EVERY person you counted in your household. Personal Property (enter 0 if none)(Required)Please enter a number greater than or equal to 0.What is the garage sale value of your personal posessions? Do you have any vehicles you do not use for transportation to work or school?(Required) Yes No If yes, list the value of the vehicle(s).Vehicles(Required)What is the value of any vehicles you do not use for transportation to work or school, such as RVs, classic cars, or boats?Do you own any real estate?(Required) Yes No If yes, list the value of that propertyReal Estate(Required)If you own any real estate, not including the home you live in, list the value of that property.Do you have a retirement account such as an IRA/401k/403b?(Required) Yes No If yes, How much money do you have in your retirement accounts? Retirement Accounts(Required)How much money do you have in IRA/401k/403b or other retirement accounts?Do you have a checking account?(Required) Yes No If yes, how much money do you have in your checking account?Checking Account(Required)How much money do you have in checking accounts?Do you have a savings account?(Required) Yes No Savings Account(Required)How much money do you have in savings accounts?Household ExpensesList only those expenses paid by the people you included in your household.Do you or any members of your household have any expenses?(Required) Yes No Examples of expenses include rent, a car payment, daycare, etc. Type of Expense(Required)mortgage or rent paymentcar paymentschild support paidgarnishmentsunreimbursed medical expensesAmount?(Required)Please enter a number greater than or equal to 0.How often do you pay this expense?(Required)every weekevery 2 weeksonce per monthannuallyDo you have other expenses?(Required)YesNoType of Expense(Required)mortgage or rent paymentcar paymentschild support paidgarnishmentsunreimbursed medical expensesAmount?(Required)Please enter a number greater than or equal to 0.How often do you pay this expense?(Required)every weekevery 2 weeksonce per monthannuallyHousingWhat is your housing situation?(Required) Rent Own Homeless Other Are you at risk of losing your housing?(Required) Yes No Is your housing at risk because of your mortgage?(Required) Yes No Which of the following best describes your rental situation? I have a private landlord and receive no ongoing rental assistance I live in a public housing facility owned by a local Housing Authority a housing voucher, Section 8, or live in a rent subsidized building I receive other rental assistance, such as General Assistance. Which of the following best describes your home? Single Family Home Mobile Home that I own Condo, Townhome, duplex, triplex Which of the following best describes your homelessness. I am living in a shelter facility for people experiencing homelessness or domestic violence. I am homeless, but have found other living arrangements, such as living with friends, or in my car? Which of the following best describes your housing situation? I am incarcerated in jail or prison I am living in a nursing home, assisted living facility, or other long-term care facility I am in a hospital Other AbuseAre you a victim of abuse (physical, emotional, mental, human trafficking, etc .)?(Required) Yes No Are you a victim of sexual assault?(Required) Yes No Are you a victim of domestic abuse?(Required) Yes No Are you a victim of stalking(Required) Yes No Are you a victim of human trafficking?(Required) Yes No What is your relationship with the person who abused you ?(Required)Spouse (current or former)Intimate Partner (current or former)Other Family or Household Member (sibling, grandparent, etc.)Acquaintance (friend, neighbor, co-worker, schoolmate, etc.)Dating RelationshipStrangerUnknownSurveysWe sometimes send satisfaction surveys by email or text. Is it ok if we send you a survey?(Required) I would prefer an emailed survey link I would prefer a text message with a survey link I would prefer not to be surveyed by either text or email If you do not wish to receive a survey, please indicate why not(Required) I don’t have access to technology I prefer surveys on paper other HiddenCase InformationHiddenHave you had any criminal charges or convictions in the last two years?(Required) Yes No Criminal charges includes (but is not limited to) traffic offenses, such as speeding tickets, driving under suspension, etc.Note: A criminal charge in the last 2 years MAY exclude you from being able to get a case set aside.HiddenWhat cases do you want to set aside or seal?(Required)HiddenIn what year(s) did these charges or convictions happen? If you do not know the exact year, please estimate the year(s) approximately and list below.(Required) Important: You will receive a call from Legal Aid to confirm your registration. You are not fully registered until you have made an appointment with Legal Aid staff. Δ