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Jury Focus Group Application

1.Contact Information(Required.)
2.What is your gender?
3.What is your date of birth?(Required.)
Date
4.I am:
5.I live:
6.What is your ethnicity? (please select all that apply)(Required.)
7.Are you employed?(Required.)
8.Please list your current position.
9.If unemployed or retired, please list your most recent position.
10.Do you now, or have you ever, worked for Norton Children's Hospital?(Required.)
11.What is the highest level of education you have completed?(Required.)
12.Do you have children?
13.Have any of your children had to be hospitalized for an extended (10 days or longer) period of time?(Required.)
14.Are you a registered voter?(Required.)
15.Political party affiliation:(Required.)
16.What is the last presidential election you voted in?(Required.)
17.With regard to jury service, I...(Required.)
18.Other than a divorce, have you ever been a party to a lawsuit?
19.Do you know, or are you related to Chris McCullum?(Required.)
20.Do you know, or are you related to Sally McCullum?(Required.)
21.I have social media accounts on:(Required.)
22.Whether television or internet, what national news organization are you likely to get your news from?
23.I have lost friends or family because of political beliefs:(Required.)
24.What is your favorite movie genre?
25.Have you ever donated your time, money or items to charity?
26.So that I can participate in a completely objective manner, I agree not to research or attempt to find any potential information regarding this matter and not to make any assumptions about the matter based on the survey questions.(Required.)
27.If selected to participate in this focus group, my preferred session is:(Required.)