Prior to being summoned, all prospective jurors are sent a Juror Qualification Questionnaire (see a sample). Please complete the form and return it to the Court within ten (10) days. A prepaid envelope has been provided for your convenience.
The Qualification Questionnaire forms are scanned electronically. If a form is not completely filled out, the scanner is unable to “read” it and therefore rejects it. Every question must be answered using a number 2 pencil (if you do not have a pencil, you may use black ink). The Questionnaire must also be signed and dated. If you are requesting an excuse, please write it on the back of the form. Please do not attach anything to the form, unless it is a doctor’s statement.
Instructions for answering each question on
the Juror Qualification Questionnaire:
| Name & Address | If your name or address is incorrect, please cross it out and write the corrections in the space provided on the right. |
| Home & Work Phone Numbers | Occasionally, we may have questions about the information you have provided on your Questionnaire. Without a telephone number, the form must be returned to you for completion. |
| County You Now Live In | It is helpful to know which county you live in so that you can be placed in the appropriate division. |
| Question 1 | You must be a natural born citizen or be a naturalized citizen of the United States of America to serve as a juror in federal court. |
| Question 2 | Please give the month, day, and year of your birth. You may be excused if you are over 70 years old and you request to be excused. If you are asking to be excused because you are over 70 years old, please indicate your age and the year of your birth and then fill in the number 1 circle under Question 15. |
| Question 3 | If you answered "No", that your primary residence was not in Indiana for the last year, name the other states and counties of primary residence and give dates. Enter this information under "Remarks" on the back side of the form. |
| Question 4 | Are you able to read and write with enough proficiency to fill out this form? Can you speak and understand the English language? |
| Questions 5 & 6 | Are there pending charges against you at this time? Have you ever been convicted of a crime where you could have been sentenced to one (1) year in jail? If you answer "Yes" to either of these questions, please give more specific information regarding the offense under "Remarks" on the back of the Questionnaire. |
| Question 7 | Were your civil rights restored? That is, can you vote and hold public office? If you are unsure, please write that under "Remarks" on the back of the Questionnaire. If you answered "No" to Questions 5 & 6, you may leave this question blank. |
| Question 8 | If you claim a mental or physical disability, please check "Yes" and explain under "Remarks" on the reverse side. Please make it clear that you are asking to be excused because of your health concern. At this stage, you will only be excused if you provide a current doctor’s statement stating that you are unable to serve. If you have a physical handicap or disability that would affect, but not prevent, your serving as a juror, and you are willing to serve if reasonable accommodation can be provided, please check "No" to this question. |
| Question 9 | Are you employed on a full time basis as a public official, police officer, firefighter or are you an active member of the armed forces of the United States of America? |
| Question 10 & 11 | Federal law requires you as a prospective juror to indicate your race. This answer is required solely to avoid discrimination in jury selection and has absolutely no bearing on qualifications for jury service. By answering these questions you help the federal court check and observe the juror selection process so that discrimination cannot occur. In this way, the federal court can fulfill the policy of the United States, which is to provide jurors who have been randomly selected from a fair cross section of the community. |
| Question 12 | Federal law requires that you answer questions about your occupation so that the federal courts may determine whether you fall within an excuse or exemption category (see Questions 9 & 14). |
| Question 14 | Although there are circles numbered 1 through 10, this court allows only five (5) possible categories of people who may be excused. These categories are: (1) Persons 70 years of age or older; (2) Persons who have served on a FEDERAL petit or grand jury within the last two years -- serving in your county is NOT a category of excuse; (3) Volunteer safety personnel (non compensated); (4) persons having responsibility for providing in-home care and custody of a child or children under the age of 10, or persons who are essential to the care of an aged or infirm persons—not working outside of the home; (5) Persons whose services are so essential to the operation of a business, commercial, or agricultural enterprise that it must close or cease to function if such person is required to perform jury duty. If you fall under one of these categories and wish to be excused you must fill in the appropriate circle. The court will review each Questionnaire to determine if you are excused or not. If you fall under one of these categories and do not want to be excused, do not fill in any of the circles. |
| Question 16 | Be sure you have signed the form. If you fail to sign the form, it will be returned to you for signature. If another person has filled out the Questionnaire for you, that person must indicate his or her name, address, and reason why under Remarks on the back of the Questionnaire. |