Grand Juror
Confirmation Form
COMPLETING the
GRAND JUROR
CONFIRMATION FORM

The Juror Confirmation Form (the Form), page 3 of your summons package, is a postcard which must be completed, signed, and mailed back to the Office of Jury Commissioner (OJC) within 10 days of its receipt.  If you have lost the Form, contact us immediately at 1-800-THE-JURY [1-800-843-5879]. If you are Hearing Impaired and have a TTY Device, please contact us at 1-800-328-3202. (If you do not have a TTY Device, you will not be able to get through on this number.)

Instructions for completing.

1. TEXT WITH IMAGES: (Click here to access instructions using text with images.)

2. Instructions using TEXT ONLY are set forth immediately below.

TEXT ONLY INSTRUCTIONS
for COMPLETING the
GRAND JUROR CONFIRMATION FORM

STEP #1: Read Page 4, "Reasons For Disqualification," of the pamphlet entitled "Grand Juror Instructions And Information" that came as a part of your summons package. 

(Click here  to view this information online.)

STEP #2: If, after reading the above, you find that you are qualified to serve as a grand juror, place an X in the blue box to the right of SECTION A of the Form.  Skip Sections B and C and proceed to STEP #4.

STEP #3: If, after reading the above, you find that your are not qualified, place an X in the blue box in SECTION B under the appropriate reason number.  In SECTION C provide the details as you were instructed in the "Reasons For Disqualification."  However, if you claim reason 9 or 10, you must send a doctor's letter along with the Form in an envelope to the address on the postcard.  Proceed to STEP #6.

STEP #4: SECTION E grants you the opportunity to exercise your privilege to postpone your date of service.  You may request to postpone to the months of January, April, July, or October, provided the month you select is within 12 months of the date for which you were originally summonsed.  In the four blue boxes in SECTION E, place your desired date in the format "MM   YY," where MM is the two-digit month number (include a leading zero if necessary) and where YY is the two-digit year number (include a leading zero if necessary).  (See the example on the Form.)

STEP #5: SECTION F applies to jurors who are hearing impaired and will require an FM assistive listening device.  If you know such a device will help you, then complete SECTION F on the Form by placing an X in the blue box.  If you have questions and have a TTY device, please call our TTY number at 1-800-328-3202.

STEP #6: Whether you are qualified to serve or not, please complete the optional survey contained in SECTION G.  The information obtained will be used in efforts to ensure that the composition of the jury pool reflects the diversity of the population of the district.   Place an X in any appropriate box next to the designation(s) that applies to you.

STEP #7: SECTION H: Date and sign the Form, and remove the black tab at the top it.

STEP #8: Mail the Form immediately (you do not need a stamp).

PLEASE NOTE: On the Form, you will find a twelve-character JUROR ID#.   This is the unique identification number the computer has assigned you for the life of this summons; please use it in any verbal, electronic, or written communication with the OJC.

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