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Copyright 1998-2018
18th Judicial District

Juror Questionnaire

You have been selected to serve as a juror in the District Court of Sedgwick County. Kansas law requires you to answer the questions on this form and submit with in the next seven days. The juror questionnaire is not a public record and is only made available to court personnel, the attorneys, and parties to the case being tried. Your cooperation and willingness to serve as a juror are appreciated.

It is Judicial Branch policy to comply with the Americans with Disabilities Act. If you have questions or concerns about jury service or if you are a person with a disability needing a reasonable accommodation to serve on a jury, please contact the court clerk promptly after receiving the summons. The clerk may be contacted by telephone at (316) 660-9101, by fax at (316) 941-5355, by email at , or via the Kansas Relay Center at 1-800-766-3777


IMPORTANT: Regardless of your personal situation, all Juror Questionnaires must be submitted for processing in a timely fashion.

No. of Dependents: Ages:
Employer: If Retired; last Employer:
Spouse's Name:
Spouse's Occupation:
Spouse's Employer:
Are you able to understand the English language 
Are you at least 18 years of age 
Are you a citizen of the United States    If no, documentation required; seeQ & A page
Are you a resident of Sedgwick county   If no, documentation required; see Q & A page
Has a court found you to be presently incompetent   If yes, documentation required; see Q & A page
Have you been convicted or pled guilty or nolo contendre to a felony within the last 10 years    If yes, documentation required; see Q & A page
Have you served as a Juror in this county in the last 12 months 
Are you a breastfeeding mother    If yes, documentation required; see Q & A page
If you believe you should be excused as a juror, please state your reason:
Thank you for taking the time to answer the questions in this Jury Questionnaire. To submit your responses, click below on the Submit button.

I declare under penalty of law that I have examined this questionnaire response form and, to the best of my knowledge and belief, it is true, complete, and correct.
I understand that I may be held in contempt of court for willfully delivering false information to the court.
By entering your name, you are signing this document  
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