SECTION A — Identity (Required)

Full Legal Name*

Date of Birth*

Mobile Phone*

Email*

Street Address*

City*

State*

ZIP*

Driver’s License / State ID Number (optional)

SECTION B — Eligibility Snapshot (Re-ask if not prefill-capable)

(If you can pre-populate from the eligibility form on /pardon/#eligibility, do so. If not, ask here.)

Have you completed your full sentence (including probation/parole)?*YesNo

Do you currently have any pending criminal charges?*YesNo

Do you owe any unpaid restitution, fines, or court fees related to the conviction(s)?*YesNoNot sure

SECTION C — Conviction History (Required)

How many convictions are you seeking a pardon for?*1234+

Conviction 1

County of Conviction*

Court Type*SuperiorStateMunicipalOther

Offense Name / Charge*

Disposition Date*

Case Number (if known)

Sentence Type*ProbationIncarcerationBothOther

Sentence End Date (if known)

Conviction 2 (optional)

County of Conviction

Court TypeSuperiorStateMunicipalOther

Offense Name / Charge

Disposition Date

Case Number

Sentence TypeProbationIncarcerationBothOther

Sentence End Date

SECTION D — Residency + Employment

How long have you lived in Georgia?*<1 yr1–33–55+

Current Employer

Job Title

Reason you are seeking a pardon (select all that apply)*Better job opportunitiesHousingProfessional licenseRestore rightsTravel / immigration considerationsPersonal closure / fresh startOther

Brief explanation (1–3 sentences)*

SECTION E — References (Used for letters)

Do you have people who can write character reference letters?*YesNo

Reference 1

Name

Phone

Relationship

How long they’ve known you

Reference 2

Name

Phone

Relationship

How long they’ve known you

Reference 3

Name

Phone

Relationship

How long they’ve known you

SECTION F — Upload Documents (Strongly Recommended)

Upload court paperwork / sentencing order

Upload proof of completion

Upload any additional supporting documents

SECTION G — Certification

I certify the information provided is true and correct to the best of my knowledge.