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Questionnaire Mock Jurors of Florida VS113
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Mock Jurors of Florida
First Name  *
Middle Name *
Last Name *
Email
 *
Phone number *
Are you a United States citizen? *
Are you a resident of Florida? *
In which Florida county do you live? *
Have you ever been convicted of a felony? *
Are you female or male as shown on your Florida ID or DL? *
What is your racial or ethnicity identification? *
What category includes your age? *
What is your occupation? If retired, what occupation did you retire from? *
What is your marital status? *
Do you have any children?     If so, how many? *
Have you ever worked in the field of medicine? If, yes specify years worked. *
Have you ever worked in the field of law?    If, yes specify years worked.
 *
Are you or any of your family and friends in law enforcement or have been in law enforcement? *
Have you or a loved one ever had a bad experience with a medical doctor? *
Have you or a loved one ever had a bad experience in a medical facility? (i.e. hospital, urgent care, ER)? *
What political party are you affiliated with? *
Are you a military veteran or in active duty? *
What is your religion? *
Which of  these describe your personal income last year? *
Are you employed by or an owner of any of the following? *
Required
What is the highest level of education you have completed?  *
Do you or a member of your family or friends have a disability, who has a physical or mental impairment that limits one or more major life activities and who to your knowledge has a history or record of such an impairment? *
What is your availability for a Mock Trial? *
Would you like to be considered for future mock juries? *
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