Juror Registration Form.

Please fill out the form below and click on the "Submit" button when finished.

Survey Password:
(This password is contained in the email invitation you received to participate,)

Your Name
(First name and Last Name without a space)
For example: JohnDoe or MaryDoe

(This will be your user name)
A password (the last four digits of your social security or driver's license number):
(This will be your password)
Postal Address Street Address

E-mail Address
Are you a US citizen? Yes No
Are you a registered voter? Yes No
Do you have a valid driving license? Yes No
Regardless of age, are you willing to serve on a jury? Yes No
Gender Male Female
Your Occupation
Highest Level of Education
Combined Family Income
Are you...? Married
A domestic partner
Please indicate how many children you have.
Do you have young children at home that you alone care for? Yes No
Do you have a mental or physical disability that would make it hard for you to serve on a jury? Yes No
Have you ever been summoned for jury duty, whether you were chosen or not? Yes No
Have you ever been convicted of a felony? Yes No
Languages spoken and understood
What is your political party preference? Democratic Republican Independent Other
In general, what are your views? Conservative Moderate Liberal

Confidentiality Statement:

In exchange for the fee I receive for taking this survey, I pledge not to copy, reproduce or transmit any part of it.