COMPLETING
the
GRAND JUROR
CONFIRMATION
FORM
(The Form)
(Text with Images Version)

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 Office of Jury Commissioner. | ![]() |
| 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 |
|
| STEP 2 |
If, after reading the above, you find that you are qualified to serve as a 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 3A |
If, after reading the above, you find that you are not qualified, place an X in the blue box in Section B under the appropriate reason number. | ![]() |
| STEP 3B |
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 juror 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). | ![]() |
| 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). If your current mailing address is different from the one to which your summons was addressed or your name has changed or is misspelled, then please make the necessary corrections in the area provided on the mailing side of the Form as shown on the right. | ![]() |
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