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. Please type your answer or click on an option where appropriate. We will keep the information confidential. Thank you.

Name (Last, First, MI or Maiden):
Date of Birth: (mm/dd/yy) Age:
Address Street Address:


Home Phone

(Area code and number)
Work Phone (Area code and number)
Cell Phone
E-mail Address
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
  State Issued
Gender Male Female
Relationship 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 (If retired or unemployed put last occupation)
Your Employer (If retired or unemployed put last employer)

Your Spouse/ Domestic Partner's Occupation

What is the highest level of education you have attained?
Degree in (if applicable)
In general, what are your views? Conservative

Have you ever participated in a research study with the Wilmington Institute?

Yes No

If you answered "Yes" to the previous question, please tell us when.
Have you ever been party to a lawsuit? Yes No

If you answered "Yes" to the previous question, please explain.
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.

Confidentiality Statement:

"I promise to keep confidential the identity of the parties, the facts and this virtual jurySM procedure."


If you are having technical problems, please email: Jurors@jurytalk.com.