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Grand Jury Questionnaire


As part of the court’s ongoing measures to protect against the spread of the COVID-19 disease, we ask that you complete the following before reporting for Grand Jury Service on January 29, 2021.

* Denotes a required field

*First Name
Middle Name
*Last Name

*1. SYMPTOMS NOW OR BETWEEN January 15, 2021, AND January 29, 2021: check any that apply to YOU or A MEMBER OF YOUR HOUSEHOLD








 

IF YOU ARE EXPERIENCING ANY OF THE ABOVE SYMPTOMS, CALL THE DISTRICT CLERK’S OFFICE at (409) 267-2432 BEFORE REPORTING ON January 29, 2021.

 

*2. CONTACT HISTORY - check any that apply to YOU or A MEMBER OF YOUR HOUSEHOLD:


 

IF ANY OF THE ABOVE APPLY, CALL THE DISTRICT CLERK’S OFFICE at (409) 267-2432 BEFORE REPORTING ON January 29, 2021.

 

3. COVID-19 RELATED EXCUSE OR EXTENSION - Individuals who are over age 65 and individuals with serious underlying health conditions, such as high blood pressure, chronic lung disease, diabetes, obesity, asthma, and those whose immune systems are compromised, such as by chemotherapy for cancer or other conditions requiring such therapy, are considered to be vulnerable populations and may request to reschedule or be excused from grand jury service at this time. If you wish to be excused or request that your grand jury service date be rescheduled, check the box below.

 

IF YOU ARE REQUESTING TO BE EXCUSED OR YOUR SERVICE DATE BE RESCHEDUELD DUE TO A COVID-19 RELATED REASON, CALL THE DISTRICT CLERK’S OFFICE at (409) 267-2432 BEFORE REPORTING ON January 29, 2021.

 

*4. FACE COVERINGS: Prospective grand jurors are required to wear a face covering while they are in the courthouse. Individuals are encouraged to bring a cloth face covering with them. If an individual does not have a cloth face covering, a disposable facemask will be provided.

 

 

Methods of Participation if Selected as a Grand Juror

 

*The Court is currently permitting jurors to appear for jury service remotely using videoconferencing technologies. Individuals who do not have the ability to appear remotely will be provided alternative methods to serve, including spaces equipped with technology or the opportunity to appear in person. Please indicate whether you have internet access and technology capability to serve remotely. Check all that apply:






 

Please provide contact information and indicate your preference concerning notifications about jury service.

*Email Address:
Mobile Phone Number (if applicable):
*I prefer to receive notifications about jury service by (check all that apply):

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