Language
English (US)
Jury Research Participant Application
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Phone Number
*
E-mail
*
Gender
*
Female
Male
Non-binary
Age
*
Years
To which ethnic group do you belong?
*
African American or Black
Caucasian or White
Hispanic or Latino
Native American
Central Asian
East Asian
Other
Marital status
*
Single
Married
Divorced
Do you have any children?
*
Yes
No
What is the age of your youngest child?
*
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Years
In which county/parish do you reside?
*
How long have you lived there?
*
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Years
Do you own or rent your home?
*
Own
Rent
Are you a registered voter?
*
Yes
No
Which of the following best describes your political views?
*
Conservative
Liberal
Do you have a computer or laptop with internet access, video, microphone and speaker capability?
*
Yes
No
Have you EVER participated in a jury research project?
*
Yes
No
How long ago was your last participation?
*
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Years
Have you ever served on a jury?
*
Yes
No
What kind of trial was it?
*
Criminal
Civil
Have you ever been convicted of a felony?
*
Yes
No
Have you ever been the injured as a result of someone's negligence?
*
Yes
No
Have you ever been the victim of a violent crime?
*
Yes
No
Have you received a mRNA vaccine for COVID-19 (Pfizer, Moderna or Johnson & Johnson)?
*
Yes
No
What is the highest level of education you have completed?
*
Less than high school
High school graduate or GED
Technical or trade school
Associate degree (2-year)
Bachelor's degree (4-year)
Master's degree
Doctoral degree
Are you a full time student?
*
Yes
No
Are you currently employed?
*
Yes
No
Occupation/Job Title
*
Where do you work?
*
Are you retired?
*
Yes
No
Are you legally disabled?
*
Yes
No
How long ago were you last employed?
*
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Months
Years
Where did you last work?
*
What was your last job title?
*
Which of the following best fits your INDIVIDUAL income per year?
*
Under $15,000
$15,000 - $30,000
$31,000 - $60,000
$61,000 - $90,000
$91,000 - $150,000
Over $150,000
Which of the following best fits your HOUSEHOLD income per year?
*
Under $15,000
$15,000 - $30,000
$31,000 - $60,000
$61,000 - $90,000
$91,000 - $150,000
Over $150,000
Have you ever been a defendant in a civil lawsuit (have you ever been sued)?
*
Yes
No
Have you ever been a plaintiff in a civil lawsuit (have you ever sued)?
*
Yes
No
Have you ever been a defendant in a criminal lawsuit (have you ever been prosecuted for a crime?)
*
Yes
No
Have you ever been a plaintiff in a criminal lawsuit (has someone else been prosecuted for a crime committed against you?)
*
Yes
No
Which of the following best describes your religious affiliation?
*
Christian
Non-religious
Spiritual
Jewish
Buddhist
Muslim
Hindu
Unitarian
Other
Do you attend worship/church services regularly?
*
Yes
No
Are you closely associated with anyone who works in the following professions? (Includes close relatives and friends, but not casual acquaintances or distant family members)
Law enforcement
Judicial system
Legal system
Military
Medical field
Automotive sales/repair
Marketing
What is your relationship to that person(s)?
*
How did you hear about this questionnaire?
*
Craigslist
Facebook
Instagram
Newspaper Classified Ad
The Southside Advocate
Baton Rouge Parents Magazine
Family, friend or acquaintance
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