Provide answer to all that are appropriate


Juror Name

Juror Number

Juror Phone Number

Juror Email Address


  1. Are you a citizen of this state 18 years of age or older who has resided in the county for at least six months preceding the time of service to serve as a grand juror?

  2. Do you hold any elective office in state or local government or who has held any such office within a period of two years preceding the time of service as a grand juror?

  3. Have you been convicted of a felony in a state or federal court who has not had his or her civil rights restored; or charged with a felony offense and who is in a pretrial release program, a pretrial release and diversion program, or a pretrial intervention and diversion program in this State, from another state, or a similar federal court diversion program for a felony offense; or has been sentenced for a felony offense pursuant to Code Section 16-13-2 and who has not completed the terms of his or her sentence; or serving a first offender sentence for a felony offense in this State or pursuant to another state's law; or is participating in a drug court division, mental health court division, veterans court division, a similar court program from another state, or a similar federal court program for a felony offense.

  4. Do you feel you have a statutory reason to be excused/exempted from grand jury service for which an affidavit pursuant to OCGA §15-12-1 would be required?

  5. Do you have an out-of-state or country commitment for an extended period of time you would contend justifies excusal or deferral at this time?

  6. Do you have any medical condition(s), vulnerabilities or other physical limitations you would contend justifies excusal or deferral at this time?

  7. Do you have any English-language difficulties or communication limitations?

  8. Have you tested positive for or are exhibiting symptoms of COVID-19, or have had recent exposure to COVID-19? You may explain.

  9. Do you have any other concerns you wish the Court to be aware you contend justifies excusal or deferral at this time?

  10. What is your employment?

  11. Are you related by blood or marriage to any of the Superior Court judges and/or the District Attorney?

  12. Have you been judicially determined to be mentally incompetent?