Request to Restrict and Seal Record

Please select a date and time for your appointment and fill in the registration form.

Fields marked with asterisk are required.

Appointment Selection

Select a date

Choose an available appointment date.

Available appointments

Please select an appointment time.

Available time slots will appear after selecting a date.

Personal Information

First Name

Last Name

Middle Name

Maiden Name

Enter N/A if this does not apply.

Date of Birth

Race

Sex

Contact Information

Phone

Format: 123-456-7890

Street Address

City

State

Zip

Format: 12345 or 12345-6789

What is the best way to reach you?

Phone

Text

Legal History

Are you currently on probation or parole in any county (misdemeanor, felony, or non-reporting)?

Yes

Do you have a pending criminal case in any jurisdiction?

Yes

Have you ever been arrested outside of the state of Georgia?

Yes

Consent and Authorization

I hereby give my consent for the Cobb County Second Chance Desk Partners (Cobb County Circuit Defender, the Office of the Solicitor General of Cobb County, or the Cobb County District Attorney's Office) to retrieve my Georgia Crime Information Center (GCIC) criminal history under purpose code U for purposes of reviewing my record to determine restriction (restriction and sealing) eligibility. I understand that my GCIC criminal history will be shared with the Georgia Justice Project (a non-profit law firm) for review and consultation at the Cobb County Second Chance Desk. This authorization is valid for 365 days.

Limited Scope Representation – Georgia Justice Project (GJP), a non-profit organization, will be my attorney for purposes of receiving and reviewing my GCIC criminal history report in preparation for my appointment at the Cobb Second Chance Desk. GJP will not disseminate or share my GCIC report beyond staff or volunteers assisting with the Cobb Second Chance Desk without my permission. GJP will not become my attorney for any other purpose absent a fully signed representation agreement between me and the Georgia Justice Project.

Signature

Electronic Signature

Type your full legal name as your electronic signature.

Date

Notes for Applicant

If you have any of the following documents, please bring them to your appointment:

Case documents for charges you want expunged
Case documents for other charges on your record
Job or housing denials due to your record
Denials or communications from occupational licensing boards
Prior requests to clean up your record