Focus Group Registration

COUNTY OF RESIDENCE *

WHAT IS YOUR PREFERRED METHOD OF COMMUNICATION? *

Phone E-mail

GENDER *

Male Female

NUMBER OF CHILDREN AND THEIR AGES *

DO ANY OF YOUR CHILDREN HAVE SPECIAL NEEDS? IF SO, WHAT? *

DO YOU RENT, OWN OR LIVE WITH FAMILY? *

RENT OWN LIVE WITH FAMILY

ANNUAL INCOME *

UNDER $30,000 $30,000 - $60,000 $60,000 - $100,000 OVER $100,000

ETHNICITY *

CAUCASIAN AFRICAN AMERICAN ASIAN OTHER

VOTING HABITS *

NOT REGISTERED - DO NOT VOTE VOTE IN ALMOST EVERY ELECTION REGISTERED BUT NEVER VOTE VOTE INFREQUENTLY

WHAT IS YOUR HIGHEST LEVEL OF EDUCATION? *

IF YOU HAVE A COLLEGE OR TECHNICAL DEGREE, IN WHAT FIELD/FIELDS? *

MILITARY SERVICE *

SERVED ACTIVE DUTY FOR FOUR YEARS SERVCED ACTIVE DUTY UNTIL RETIREMENT SERVED ACTIVE DUTY MORE THAN FOUR YEARS SERVED IN THE GUARD PREVIOUSLY SERVE CURRENTLY IN THE GUARD DID NOT SERVE IN THE MILITARY

IF YOU SERVED IN THE MILITARY, WHAT BRANCH? *

ARE YOU RECEIVING OR HAVE YOU EVER RECEIVED PUBLIC ASSISTANCE SUCH AS FOOD STAMPS, WELFARE, SSD, ECT.? IF NO, TYPE N/A *

ARE YOU A MEMBER OF A UNION? IF SO, WHICH ONE(S)? IF NOT, TYPE N/A *

PRESENT OR MOST RECENT EMPLOYER, DATES OF EMPLOYMENT AND JOB DUTIES *

NEXT PREVIOUS EMPLOYER, DATES OF EMPLOYMENT AND JOB DUTIES *

DO YOU HAVE ANY LONG-TERM HEALTH CONDITIONS? IF SO, PLEASE EXPLAIN *

WHAT IS YOUR GENERAL OPINION OF THE LEGAL INDUSTRY? *

EXTREMELY POSITIVE POSITIVE NEUTRAL EXTREMELY NEGATIVE

HAVE YOU OR ANYONE IN YOUR FAMILY SUED OR BEEN SUED BY ANYONE? *

YES NO

IF YES, PLEASE EXPLAIN *

HAVE YOU EVER BEEN IN A CAR WRECK AND WERE YOU INJURED? HOW DID YOU HANDLE THE SITUATION [CHECK ALL THAT APPLY] *

NEVER BEEN IN A CAR WRECK BEEN IN A CAR WRECK BUT WAS NOT INJURED BEEN IN A CAR WRECK AND WAS INJURED SLIGHTLY BEEN IN A CAR WRECK WITH SEVERE INJURIES FILED A CLAIM AGAINST INSURANCE COMPANY - NO SUIT FILED A LAWSUIT AND IT SETTLED

WHAT PUBLICATIONS DO YOU REGULARLY READ? PLEASE LIST AT LEAST THREE *

WHAT ARE YOUR FAVORITE TV SHOWS? PLEASE LIST AT LEAST THREE *

DO YOU LISTEN TO TALK RADIO? IF SO, WHAT SHOWS ARE YOUR FAVORITES? *

DO YOU SUBSCRIBE TO ANY SOCIAL NETWORKING SITES (SUCH AS FACEBOOK AND TWITTER)? IF SO, WHICH ONES? *

HOW MUCH TIME PER DAY DO YOU SPEND ON SOCIAL NETWORKING SITES? *

DO YOU ATTEND CHURCH? IF SO, WHERE AND HOW REGULARLY? *

PLEASE LIST ANY ORGANIZATIONS OR CLUBS YOU BELONG TO *

HAVE YOU EVER BEEN ARRESTED OR CONVICTED OF A CRIME? IF SO, WHAT? *

PLEASE DETAIL ANY OTHER INFORMATION YOU THINK MIGHT BE HELPFUL IN UNDERSTANDING HOW YOU THINK *

PLEASE LIST ANY FRIENDS OR FAMILY MEMBERS THAT YOU KNOW OF WHO HAVE FILLED OUT THIS REGISTRATION FORM *

Focus Group Registration For Participants as Mock Jurors
Your personal information will never be shared with anyone. It is needed solely for demographic purposes and will remain confidential.

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Our People

Contact

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Focus Group Registration For Participants as Mock Jurors*Your personal information will never be shared with anyone. It is needed solely for demographic purposes and will remain confidential.*

﻿Our Facility﻿

Our People

Contact

For Reporters

Focus Group Registration For Participants as Mock Jurors
Your personal information will never be shared with anyone. It is needed solely for demographic purposes and will remain confidential.

Our Facility