Jury Questionnaire

Your participation as a juror is very important to us.
Your thoughts, feelings, beliefs, and decisions about this case and the issues presented will help determine whether the case can be settled or whether it will go to trial.
This research will also help indicate who is likely to win the trial.

All fields are required.

We will keep the information confidential. Thank you.

Date (mm/dd/yy)
Name (Last, First, MI or Maiden)
Date of Birth (mm/dd/yy)	Age
Address	Street Address
	City State Zipcode County
Home Phone	(Area code and number)
Work Phone	(Area code and number)
E-mail Address
How do you access the Internet? (Please tick the one that best applies.)	Dial up (ISP) DSL Cable T1
Please indicate which web browser you use.
Are you a US Citizen?	Yes No
Are you a registered voter?	Yes No
Political Affiliation	Republican Democrat Ind Other
Do you have a current valid state driver's license?	Yes No
	State Issued
Gender	Male Female
Marital Status	Married Divorced Widowed Single Separated Living With Someone
Please indicate how many children you have.
Do you supervise minor children at your home?	Yes No
Your Occupation
Your Spouse/ Domestic Partner's Occupation
What is the highest level of education you have attained?
Ethnicity
Religion
Have you ever participated in a research study with the Wilmington Institute or anywhere else?	Yes No If you answered "Yes" to the previous question, please tell us WHEN and WHERE.
Have you ever been party to a lawsuit?	Yes No
	If you answered "Yes" to the previous question, please explain.
Has your spouse/domestic partner ever been a defendant in a criminal case involving a felony?	Yes No
Have you ever been convicted of a felony?	Yes No
Do you currently have a jury summons?	Yes No
Are you studying law or have you worked for a law firm?	Yes No
	If you answered "Yes" to the previous question, please explain.