Fields marked with a * are required.
District of Columbia
Zip / Post Code
What is your present age?
How old were you at the time of offense?
What was the approximate date of your offense?
How many years has it been since your offense?
What is your current registration status?
Released Required to Register
What is your current family situation or Status?
Living Alone (unmarried)
Living with non-familial roommate
Living with Family
What is your Highest Education Level?
Do you have children?
4 or more
Did your case involve Child Pornography (other than production)?
Does your case qualify as a Romeo and Juliet Offense? (Requirements for R&J: a four year difference between victim while the charged was18 or younger at the time. Also, has completed mandatory requirements of prison and/or probation)
Were you a minor when you committed your offense?
Have you been charged with a new criminal offense since being registered? (Note: Other than the offense for which you originally had to register) *
Please indicate whether your status as a registrant has caused any of the following situations to apply to you and describe the circumstances below: (Check all that apply).
I have been denied an otherwise suitable and affordable residence.
I have submitted 10 or more prospective residences to probation/police which have been denied.
I have been unable to move in with a family member other than a spouse (into their existing residence).
I have been unable to live with my spouse (into their existing residence).
I have been forced to move from a residence.
I have been harassed by people in the community over my registration status.
I have been unable to attend my own child’s school or athletic events.
I have been unable to attend a religious service.
I have been homeless for a period of time (though I could have stayed with family/friends).
I have been denied admission to a homeless/emergency shelter because of my registration status.
I have been unable to find or maintain employment because of my registration status.
I have been terminated from a job solely because of my registration status.
I am required to register ___ times per year.
Even though I am only required to register that many times per year, I had to appear at the registration office ____ times, in person, because of travel, residence change, employment change, vehicle change, or other reason.
Please describe your situation fully in the box below. Be sure to include any additional information you feel would be helpful in evaluating your case. Please do not include information concerning your offense, only how the registration requirements have impacted yours and your family's lives.
If you are a human and are seeing this field, please leave it blank.