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2. Are you qualified to serve as a juror?*

   RCW 2.36.070 states a person is competent to serve as a juror unless that person:

   1. Is less than eighteen (18) years of age; 
   2. Is not a citizen of the United States; 
   3. Is not a resident of the county in which they have been summoned to serve; 
   4. Is not able to communicate in the English language; or 
   5. Has been convicted of a felony and has not had their civil rights restored.

   1. Yes, I am qualified
   2. Yes, I am qualified, but I am requesting a hardship excuse or postponement for the following reason (list reason below)
   3. No, I am not qualified to serve as a juror due to one of the qualifiers listed above
4. If you were not qualified, select the condition you did not meet.

   1. I am not at least 18 years of age
   2. I am not a United States citizen
   3. I am not a resident of the county I was served in
   4. I am not able to communicate in English
   5. I have been convicted of a felony and have not had my civil rights restored
6. If you are requesting a hardship excuse or postponement, please describe your reason.
10. Questionnaire
12. First Name*
13. Last Name*
15. Phone Number*
17. Marital Status*

    1. Single
    2. Married
    3. Divorced
    4. Seperated
    5. Widowed
18. Number of Children*
20. Your occupation, or if retired, your former occupation:*
22. Spouse's name and occupation if applicable:
24. Have you or any member of your immediate family been a party to any criminal or traffic litigation in court?*

    1. Yes
    2. No
26. If answered yes, please list when and in which court below.
30. The following questions do not affect your ability to serve. They are included to assist us in planning.
32. Do you have access to, or the capability to operate, a secure video conferencing platform (e.g. Zoom) via Wi-Fi, if the court conducts a remote hearing?*

    1. Yes
    2. No
34. Do you have a computer or laptop with a video camera?*

    1. Yes
    2. No
36. Do you have access to a quiet and private space for the duration of a video hearing?*

    1. Yes
    2. No
40. Thank you for responding to your juror summons.
    
    If you are qualified to serve as a juror, you will be contacted by the court clerk’s office on the Friday afternoon, prior to your week of jury service with further instructions.
    If your request for excusal is denied, you will be contacted by the court within 5 days of sending in your request.
    If you have not been contacted by the court, you may consider yourself excused for this jury term.
42. Electronic Signature*
43. Email Address*
Leave This Blank:


44. 1. Receive an email copy of this form.
45. Email address

    This field is not part of the form submission.

46. Submit

* indicates a required field