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Download a copy, print it, send it by email, or mail it via USPS—whatever works best for your next step.

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If this form requires notarization, complete it online through a secure video call—no need to meet a notary in person or wait for an appointment.

We protect your documents and personal data by following strict security and privacy standards.
It's the law! Virginia law requires that we randomly (done electronically) select a number of citizens (35,000) to receive the Questionnaire which then allows the court to either qualify or disqualify residents for service based upon your answers to the questions in the form.
Failure to complete and return a jury questionnaire, providing false information on the questionnaire, or using vulgar or profane language in response to a jury questionnaire subjects a citizen to show cause proceeding for contempt of court.
Failure to complete and/or mail in the response may require you to appear at the courthouse to complete the form.
It's the law! Virginia law requires that we randomly (done electronically) select a number of citizens (35,000) to receive the Questionnaire which then allows the court to either qualify or disqualify residents for service based upon your answers to the questions in the form.
I am requesting a jury duty excusal because of my personal obligation to provide necessary and actual care to my two children. My elder child, Amy, is 3 years old and my younger child, Andrew, is 1 year old. They require constant care and attention and I do not have anyone with whom I can leave them full time.
Failure to complete and return a jury questionnaire, providing false information on the questionnaire, or using vulgar or profane language in response to a jury questionnaire subjects a citizen to show cause proceeding for contempt of court.
The consequences of not reporting for jury service are severe. You could be escorted to the courthouse by a deputy U.S. marshal to explain to a judge why you did not report. You also could be fined up to $1000, imprisoned for up to three days, ordered to perform community service, or any combination of the three.
Active Duty Military. Full Time Students. Non-accommodating Medical Conditions. Individuals who served less that ten years ago with the State Court (this excludes Federal Court)
Reasons you may be excused from jury service include: You have no means of transportation. You would have to travel an excessive distance to the courthouse. You have a physical or mental impairment. You provide care for a dependent and cannot afford to have someone cover for you.
Among the more common reasons jury service is excused are: Your age. You are not a U.S. citizen. You have a medical condition that would impede your jury service. You recently served on a jury in state or federal court.