DRAFT: 2026 Expungement Clinic & Resource Fair Pre-Registration

Southfield Alumnae Chapter | Delta Sigma Theta Sorority, Incorporated

By completing this form, you agree to provide Delta Sigma Theta Sorority Inc., the Michigan Attorney General's Office, Safe & Just Michigan, and its legal partners with accurate information including but not limited to current and former names as well as an accurate date of birth, so as to ensure an accurate and complete Criminal History Report. Failure to provide accurate information on your registration form, may result in an inaccurate eligibility determination. Your Criminal History Report will be reviewed by our legal partners in order to determine your eligibility for expungement under Michigan Law. The information provided in this form may be used for expungement screening of participants in the future.

Furthermore, completion of this form releases Delta Sigma Theta Sorority, Inc., the Michigan Attorney General's Office, Safe & Just Michigan, and all volunteer attorneys associated with this event, officers, directors, employees, and agents from all liability relating to the legal services provided, whether for malpractice, professional negligence, breach of fiduciary duty, or other cause.

NO ONGOING ATTORNEY-CLIENT RELATIONSHIP SHALL BE ESTABLISHED BASED UPON THE COMPLETION OF THIS FORM OR YOUR CONSULTATION WITH ANY OF THE VOLUNTEER ATTORNEYS INVOLVED WITH THE EXPUNGEMENT SCREENING PROCESS.
Where do you reside?

Where do you reside? Oakland County City of Detroit (PCS) - Zip Code 48201-48244 Wayne County (Outside of the city of Detroit) Macomb County Another county or area not listed above
First Name
Last Name
Email

Confirm Email Address
Former alias(es) and all other previous names (married and maiden names). If not applicable, enter N/A.
Date of Birth Date of Birth / MM / DD YYYY
Race

Race Black White American Indian or Alaskan Native Asian or Pacific Islander Arab American/MENA Unknown/Other
Gender

Gender Female Male Other or Unknown
Phone Number Phone Number - ### - ### ####
Please indicate the primary conviction you would like to expunge, along with the year it occurred (e.g., 2001 retail fraud-3rd degree or 2010 felonious assault).
Is/Are the conviction(s) you want expunged any of the following? Select all that apply.

Is/Are the conviction(s) you want expunged any of the following? Select all that apply. DUI-2nd- Felony DUI-3rd Federal conviction Outside the state of Michigan Criminal sexual conduct (CSC) 1st, 2nd, 3rd degree Juvenile offense Traffic offense causing Injury or Death An offense that was punishable by life imprisonment (e.g., Armed Robbery, Murder, Child Abuse 1st Degree) None of the Above
Please indicate below which court(s) your conviction(s) originated from. Select all that apply.

Please indicate below which court(s) your conviction(s) originated from. Select all that apply. 16th Circuit Court (all felony cases from Macomb county are bound over to this court) 37th District Court (Warren) 38th District Court (Eastpointe) 39th District Court (Roseville) 40th District Court (St. Claire Shores) 41A District Court (Sterling Heights) 41B District Court (Mt. Clemens) 42nd District Court (New Baltimore and Romeo) 3rd Circuit Court (all felony cases from Wayne county are bound over to this court) 24th District Court-(Cities of Allen Park and Melvindale) 25th District Court (Cities of Ecorse and Lincoln Park) 27th District Court (City of Wyandotte) 28th District Court (City of Southgate) 29th District Court (Wayne City) 30th District Court (City of Highland Park) 31st District Court (City of Hamtramck) 32A District Court (City of Harper Woods) 33rd District Court Wayne (City of Woodhaven) 34th District Court (City of Romulus) 35th District Court (City of Plymouth) 36th District Court (City of Detroit) 6th Circuit Court (all felony cases from Oakland county are bound over to this court) 43rd District Court (Ferndale, Hazel Park, Madison Heights) 44th District Court (Royal Oak) 45th District Court (Oak Park) 46th District Court (Southfield) 47th District Court (Farmington Hills) 48th District Court (Bloomfield Hills) 50th District Court (Pontiac) 51st District Court (Waterford) 52nd District Court (Novi, Clarkston, Rochester Hills, Troy) Convicting court is outside of Wayne, Oakland, and Macomb County
Have you been convicted of more than three unrelated felony convictions?

Have you been convicted of more than three unrelated felony convictions? Yes No Not sure
Do you have any criminal charges pending against you at this time (awaiting trial , pretrial conference, preliminary examination etc on any case)?

Do you have any criminal charges pending against you at this time (awaiting trial , pretrial conference, preliminary examination etc on any case)? Yes No
Do you have any out-of-state convictions?

Do you have any out-of-state convictions? Yes No
Do you currently owe fines, court costs, or restitution on the offense that you would like to have expunged?

Do you currently owe fines, court costs, or restitution on the offense that you would like to have expunged? Yes No
Why are you seeking an expungement? Select all that apply.

Why are you seeking an expungement? Select all that apply. Access housing New or better employment opportunities Obtain federal financial aid Obtain state/federal/local license Remove stigma Another reason listed above
What is your employment status?

What is your employment status? Full time Part time Self-employed Unemployed Retired Disabled Student
How did you find out about this event?

How did you find out about this event? News media Social media/internet Family or friend City of Detroit (employee/email/website) Court Detroit at Work Detroit Justice Center Detroit Police Department Detroit Public Schools Michigan State Police Michigan Department of Corrections Michigan Works! Church Skills for Life Michigan Department of Attorney General Organization of Exonerees Other Other
Is there anything else you would like us to know (recent criminal convictions, outstanding warrants etc.)?
Attendance at the Expungement Clinic is required in order for eligible participants to take advantage of this event.

If you require any assistance completing this application, please send an email to socialaction@deltasac.org.

DRAFT: 2026 Expungement Clinic & Resource Fair Pre-Registration

DRAFT: 2026 Expungement Clinic & Resource Fair Pre-Registration

Attendance at the Expungement Clinic is required in order for eligible participants to take advantage of this event. If you require any assistance completing this application, please send an email to socialaction@deltasac.org.

Attendance at the Expungement Clinic is required in order for eligible participants to take advantage of this event.

If you require any assistance completing this application, please send an email to socialaction@deltasac.org.