ECI Clean Slate Cooperative Application for Legal Services
The Earl Carl Institute Clean Slate Cooperative assists with clearing criminal records for individuals whose crimes occurred on or before their 25th birthday and who live in Harris County, Texas. For individuals who live in Brazoria County, Chambers County,
Fort Bend County, Galveston County, Liberty County, Montgomery County or Waller County, we may be able to assist with the preparation of pro se legal documents to help you with getting your criminal record
cleared on your own.
Privacy Policy
All information received from an applicant is strictly confidential. Our firm makes every effort to protect your personal privacy. The data submitted via this form
is encrypted and secured using industry-standard 128-bit SSL encryption.
Your Social Security
number and other personal information will only be used in the event that you hire the firm to represent you in your legal matter, and then, only when necessary in limited use during the course of your case.
If you have any questions, please don't hesitate to contact
us at 713-313-4876. This application will take about 10 minutes to complete.
Contact information
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First name
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*
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Upon submission, a copy of this form will be sent to the primary email.
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Primary
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Date of Birth
Driver's License Number
Social Security Number
Are you a US Citizen?
Yes
No
Are you a Legal Resident?
IF YOU ARE AN ELIGIBLE LEGAL RESIDENT ALIEN, PLEASE STATE WHAT DOCUMENT AND/OR PROOF THAT YOU ARE ABLE TO PROVIDE ECI CONTAINING YOUR UNITED STATES CITIZENSHIP AND IMMIGRATION SERVICES STATUS
Gender
What gender do you identify with?
Select an Option
Male
Female
Transgender
Nonbinary
Prefer Not to Say
Race
Select an Option
Asian/Pacific Islander
Black
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Highest Educational Level Completed
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Did not complete high school
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How were you referred to ECI?
Houston Bar Association
Houston Lawyers Association
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Please provide the name of the Government Official
Friend or Relative
Please provide the name of the friend or relative
Other Legal Services Provider
Please provide the name of the Legal Services Provider
Media or Advertisement
Please provide the name of the media outlet or advertiser
Church or Religious Organization
Please provide the name of the church or religious organization
Workforce Solutions
NAACP
Houston Volunteer Lawyers
Court and/or Judge
Please provide the court number and location and/or judge
TSU or TMSL Student or Employee
Please provide the name of the TSU or TMSL Student or Employee
Other
Please provide the name of the other referral source
Demographic Information
Are you a victim of domestic violence?
Yes
No
Are you disabled?
Yes
No
Are you a veteran?
Yes
No
Are you a member of the LGBTQ community?
Yes
No
Have you been involved in the foster care system?
Yes
No
Are you homeless?
Yes
No
Are you currently confined to jail or prison?
Yes
No
Are you currently represented by an attorney?
Yes
What attorney or legal service provider is assisting you with this case?
Please provide the name and phone number of the attorney
No
Financial Eligibility Questions
The Clean Slate Cooperative does not have income eligibility requirements. Income information is collected for statistical purposes to provide to our funder and may be needed for the Court to assist with getting court costs and fees waived in your case. Please answer the questions below so that we can determine your eligibility.
How many people live in your household?
Please answer in number format. Example: "1", "4", "3"...
Select everyone who lives in your household
Check all that apply
Self
Spouse
Child 1
Child 2
Child 3
Other Dependent(s)
Household Income
Please select all that apply. If a person lives with their family, add income of all family members. Family includes only those persons related by blood or by law as relatives to the applicants for whom the applicant has a legal responsibility to support.
Work Wages
How much every month?
Includes self-employed. Total for every member in your household
Unemployment
How much every month?
Total for every member in your household
Supplemental Security Income (SSI)/Social Security Disability Insurance (SSDI)
How much every month?
Total for every member in your household
Child/Spousal Support
How much every month?
Total for every member in your household
Retirement/Pension
How much every month?
Total for every member in your household
Food Stamps/SNAP Benefits
How much every month?
Total for every member in your household
Other Household Income
How much every month?
Total for every member in your household
Do you or any household member own any of the following assets?
A home other than your primary residence
If so, please provide the address and value of that property
A savings account
If so, please provide the value of that account
A retirement account
If so, please provide the type of account and its value
Cash on hand
If so, please tell us how much cash you have on hand
Neither I nor anyone in my household own any other assets
Case Facts
Please provide a brief description of the legal problem that you need assistance with. Include important names and dates, if known.
In what county was your criminal case filed?
You will need to complete an additional application for cases in counties not listed.
Select an Option
Brazoria County
Chambers County
Fort Bend County
Galveston County
Harris County
Liberty County
Montgomery County
Waller County
Other County
Criminal Cause Number(s), if known
What was your age at the time of your arrest?
Select an Option
25 years or younger
Older than 25 years
I don't recall
Have you previously tried to have your record cleared?
Yes
What was the outcome of that attempt?
No
Are you aware of any open warrants for your arrest?
Yes
What Court is the open warrant in?
No
ACKNOWLEDGEMENTS
Your completed application will be reviewed to determine if representation is appropriate, determine the scope of representation and assignment of the appropriate case handler, who may be a volunteer attorney.
The case review and assignment process can take up to 3 weeks depending on current volume, though some cases will be approved and assigned sooner. You will be contacted by your case handler once your case has been assigned.
At this time there is no Attorney/Client Relationship. This means that your case is NOT being accepted for representation at this time. However, it is under review to see if there is a legally viable means of assisting you. Therefore you are responsible for meeting any legal deadlines in your case on your own until we or another attorney provide you written notice that your case has been accepted.
THE INFORMATION PROVIDED IS A TRUE AND ACCURATE STATEMENT OF MY FINANCIAL SITUATION (INCLUDING THE INCOME OF ALL FAMILY MEMBERS WITH WHOM I RESIDE) AND THE FACTS CONCERNING MY PROBLEM.
Yes
No
I confirm that I have named all persons who I believe have an interest in my case. I understand that if a conflict of interest arises from the facts of my case, my case will be closed.
Yes
No
You agree that everything submitted and stated within this application is true.
Yes
No
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