JURY QUESTIONNAIRE

Name:_____Address: _____Email Address:_____ Home Phone:_____Work Phone: _____Cell Phone: _____Date of Birth: _____Age: _____To receive text notifications, list the cell phone carrier:Marital Status:_____Age(s) of Children:_____Number of Children:_____Spouse s Name:_____Spouse s Occ:_____Spouse s Emp:_____Occupation:_____Employer: _____Level of Education: _____Are you a United States Citizen?YesAutomatic exemptions are not allowed for reasons of inconvenience, hardship, or age.** There is not an exemption from jury service based solely on age. Exemptions must be based on some other good cause. An example of good cause would be pursuant to Iowa Code section concerning a vulnerable elder; Vulnerable elder means a person sixty years of age or older who is unable to protect himself or herself from elder abuse as a result of age or a mental or physical condition or because of a personal circumstanc

of this form and return it to the Jury Manager. When responding to your questionnaire, whether by paper or through the online questionnaire, please provide an email address and/or cell phone number and carrier information so that the Jury Manager can send updates and notifications regarding your jury service.

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