Participant Questionnaire

Participant Registration Form.

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

Age:
Are you a US citizen?	Yes No
Are you a registered voter?	Yes No
Political affiliation	Republican Democrat Independent Other
Do you have a driver's license?	Yes No
	State Issued
Gender	Male Female
Relationship status	Married Single Domestic Partner
Please indicate how many children you have.
Are you the only care giver for children at your home?	Yes No
Your Occupation
What is the highest level of education you have attained?
Combined Family Income?
In general, what are your views?	Conservative Moderate Liberal
Ethnicity
Religion
Languages spoken and understood
Have you ever been convicted of a felony?	Yes No
Do you currently have a jury summons?	Yes No