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1. Last Name
2. First Name
3. Gender
4. Age
5. Marital Status
6. Spouse's First Name
7. Spouse's Last Name
8. Cell Phone
9. Work Phone
10. Email
11. City
12. State
13. County
14. Ethnicity
15. Are you a registered voter?  Yes No
16. Do you or anyone you know work for the media?  Yes No
17. In the past two years, how many focus groups, mock trials or jury studies have you participated in?
18. Would you describe yourself as:
19. Are you currently a student?  Yes No
20. Education Level
21. What Major(s)/Degree(s)?
22. Employer's Name
23. Describe your business/industry
24. Do you consider your current job to be:
25. Occupation
26. Have you ever worked in the legal field?  Yes No
27. If yes, please tell us who you worked for:
28. Do you know any lawyers or judges on a personal or professional basis?  Yes No
29. If yes, please tell us their names:
30. Have you ever served on a jury in a:
31. Prior Jury Service Yes or No If yes, how many times?
  Civil  Yes No
  Criminal  Yes No
  Grand Jury  Yes No
  Never served  Yes No  
32. Referred by