Thank you for the participating in this survey. Your story will help us gain valuable information about the various collateral consequences associated with a conviction.
What is your name? *
What is your phone number?
What is your email address? *
What is the best way to contact you?
What is your gender?
What is your age?
What is your race?
Were you convicted through a plea or a trial?
In what state was your conviction? *
What was the date of your conviction?
What were the specific offense(s) for which you were convicted?
Were you convicted as a junvenile?
If incarcerated, what was the date of your release?
Rights Lost and Restored
What rights and privileges did you lose (voting, employment, housing, etc.)?
Did you receive any of the following remedies:
In your jurisdiction, do you have have to apply to have rights restored (voting rights, firearms license, etc.)?
If you did apply, what was the outcome?
If you did receive a remedy, what rights were restored?
Is there any other information or comments you wish to share with us?
How your information will be used
NACDL appreciates the information you have provided us regarding collateral consequences you have experienced as a result of your conviction. We have conducted research around the country for over two years and are well aware of the sensitivities around having a conviction on one's record. While we cannot guarantee the use of any particular story, we will ensure that the information you provided is accurate as you have reported it. We will also contact you to let you know what segments of your information we intend to use in our report, website, press releases or any other materials associated with the project.
In submitting your information you agree to not hold NACDL liable for any actions that may be taken against you by any entity due to your conviction.
Again we thank you for participating in a process in which we hope will effectively address polices that negatively impact an individual's potential for reentering communities and society as a whole post-conviction.
I approve my information being used in NACDL's Post Conviction Study . *
If we use your story, can we include your actual name in the report? *
For more information contact Angelyn C. Frazer at email@example.com or (202) 465-7642.