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Biographical Information: This helps us look up more documentation and records, if necessary.
Full Name
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Full Name at Time of Arrest (if different):
Please enter your full name at the time of arrest - if it is now different.
Sex
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Race
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Date of Birth
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Email Address
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Phone Number
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Case Information: In this section, please fill out as many questions as you can. If you don’t know the answer, you can leave it blank. Please answer the same questions on the additional tables provided if you have more than one offense. It is important to our analysis that we know your full history of charges.
Offense 1
Offense:
Disposition (deferred, dismissed, declined, acquitted, convicted, probation, etc.):
Date of Offense:
Date of Arrest:
Police Agency (list all involved):
County of Arrest:
City of Arrest:
Jail:
Court:
Case Number:
Offense 2
Offense:
Disposition (deferred, dismissed, declined, acquitted, convicted, probation, etc.):
Date of Offense:
Date of Arrest:
Police Agency (list all involved):
County of Arrest:
City of Arrest:
Jail:
Court:
Case Number:
Offense 3
Offense:
Disposition (deferred, dismissed, declined, acquitted, convicted, probation, etc.):
Date of Offense:
Date of Arrest:
Police Agency (list all involved):
County of Arrest:
City of Arrest:
Jail:
Court:
Case Number:
Offense 4
Offense:
Disposition (deferred, dismissed, declined, acquitted, convicted, probation, etc.):
Date of Offense:
Date of Arrest:
Police Agency (list all involved):
County of Arrest:
City of Arrest:
Jail:
Court:
Case Number:
Offense 5
Offense:
Disposition (deferred, dismissed, declined, acquitted, convicted, probation, etc.):
Date of Offense:
Date of Arrest:
Police Agency (list all involved):
County of Arrest:
City of Arrest:
Jail:
Court:
Case Number:
Additional Information: