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Grand Jury Questionnaire

The following "Juror Questionnaire" is mandated by Government Code, Section 62.0132


Your answers are CONFIDENTIAL under Article 19.42, Code of Criminal Procedure, and may only be disclosed to a party to a proceeding if the court, on a showing of good cause, permits it.

* Denotes a required field

*Grand Jury Summons Number Please enter all 15-17 digits
*Last Name
*First Name
Middle Name
*Date of Birth (Format MM/DD/YYYY)
*Home Street Address
Mailing Address (If Different)
City (If Different)
State (If Different)
Zip (If Different)
*County Of Residence
*Phone type:
*Phone Number
*Preferred Method Of Contact

If By Mail: By choosing this option all notices, including summons, will be mailed to you. It is your responsibility to contact the jury coordinator for updates on the status of your service. A lack of receipt of mail will not be an acceptable excuse for missing service.

*Your Occupation
*Your Employer
*How Long?
*Marital Status
Spouse's Name
Spouse's Occupation
Spouse's Employer
How Long?
*Are you a U.S. Citizen?
Note: If you state that you are not a U.S. citizen, you may no longer be eligible to vote and may be required to provide proof of U.S. Citizenship to your county voter registrar.
*Highest Level of Education Completed:
Number of Children
Age Ranges
*Have you ever served on a grand jury?
If yes, what months/year?
*Have you ever served on a criminal jury?
*Do you have access to the internet to be able to attend a virtual impanelment process?



(Texas Code of Criminal Procedure, Article 19.08)

If you do not meet all of the below qualifications you cannot serve.


A person may be selected as a grand juror only if the person:

*I am at least 18 years of age
*I am a citizen of the United States
*I am a resident of this state and a resident of Chambers County
*I am qualified under the Constitution and laws to vote in the county in which you are to serve as a grand juror, regardless of whether you are registered to vote
*I am of sound mind and good moral character
*I am able to read and write
*I have not been convicted of misdemeanor theft or a felony
*I am not under indictment or other legal accusation for misdemeanor theft or a felony
*I am not related within the third degree of consanguinity or second degree of affinity, as determined under Chapter 574, Government Code, to any person selected to serve or serving on the same grand jury
*I have not served as a grand juror in the year before the date on which the term of court for which you have have been selected as a grand juror begins
*I am not a complainant in any matter to be heard by the grand jury during the term of court for which you have been selected as a grand juror


(Texas Code of Criminal Procedure, Article 19.25)

You must report for grand jury service unless you qualify to claim an excuse under this code 

Check all that apply

Note: The court also may determine if a person has a reasonable excuse from service other than those listed above.

Jury Service COVID-19 Pre-Screening Questionnaire

In consideration of the health and safety of the local community and court staff we are requiring this online questionnaire to be completed accurately.


*Check any symptoms that apply to you or a member of your household

Contact History: Check any that apply to you or a member of your household

COVID-19 Related Extension or Excuse

Individuals who are over age 65 and individual 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 jury service at this time.  If you wish to be excused or request that your service date be rescheduled, check the box below.

COVID Related Rescheduling:

Payment for Jury Service


You may choose to be paid cash for your service or donate to the following entities.

Texas State Crime Victims Compensation Fund: In 1979, the Texas Legislature passed the Crime Victims’ Compensation Act, creating the Compensation to Victims of Crime Fund and the Crime Victims’ Compensation (CVC) Program. The primary purpose of the Fund is encouraging greater victim participation in the apprehension and prosecution of criminals and reimbursing innocent victims for certain out-of-pocket expenses incurred as a result of violent crime.

Chambers County Child Welfare Board (foster children care): To provide coordinated state and local public welfare services for children and their families and for the coordinated use of federal, state, and local funds for these services under the direction of a child welfare board created by commissioners court.

Chambers County Fallen Officers Memorial Fund: To provide financial assistance to families of fallen law enforcement officers of Chambers County.

Please choose one of the following for your payment for service

Right to Reemployment: An employer may not discharge, threaten to discharge, intimidate, or coerce any permanent employee because the employee serves as a juror, or for the employee’s attendance or scheduled attendance in connection with the service, in any court in the United States. An employee, who is discharged, threatened with discharge, intimidated, or coerced in violation of this section is entitled to return to the same employment that the employee held when summoned for jury service if the employee, as soon as practical after release from jury service, gives the employer actual notice that the employee intends to return. (Civil Practice and Remedies Code, Section 122.001).


Failure to Answer Summons and Provision of False Information: A person may be fined not less than $100 nor more than $500 if the person fails to attend court in obedience to this summons without reasonable excuse. (Code of Criminal Procedure, Article 19.16).


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