`Case 6:21-cv-00569-ADA Document 219-1 Filed 06/20/23 Page 1 of 5
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`JURY QUESTIONNAIRE
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`Name:
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`Date of Birth:
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`Case 6:21-cv-00569-ADA Document 219-1 Filed 06/20/23 Page 2 of 5
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`Gender:
`Address:
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`Birthplace:
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`How long have you lived at your current home or residence?
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`Education:
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`Highest grade/degree completed:
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`College or Vocational School:
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`Major or Area(s) of Study:
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`Employment: Full-time
`Part-time
`Student Unemployed-Seeking Work Retired
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`Disabled Other
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`If “Other,” please describe:
`Occupation:
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`Describe Job Duties:
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`Job Title:
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`Employer (current or most recent):
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`Previous Jobs (if any):
`Have you ever worked in a position in which you supervised others: Yes No
`In what area(s) have you received special education or training? _____________________
`Have you ever served in the military: Yes No
`If yes, what branch, and what was the highest rank you achieved?
`Are you currently married or living with a significant other? Yes No
`If your spouse/significant other works, who is his/her employer?
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`Occupation(s) of other adults in your household:
`Number of children:
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`Ages of children:
`Occupation(s) of adult children:
`Regarding lawsuits (other than a divorce), have you been a: [Check all that apply]
`Plaintiff Defendant Witness Unsure Never been involved in a lawsuit
`Please explain:_______________________________________________________________
`Have you ever worked for the government (local, state, or federal)? Yes No
`If yes, please explain: _________________________________________________________
`Have you or anyone close to you ever worked at a job where you or they were involved in the
`development or marketing of new products? Yes No
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`Case 6:21-cv-00569-ADA Document 219-1 Filed 06/20/23 Page 3 of 5
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`If yes, please explain: _________________________________________________________
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`Please list any clubs, groups, churches, unions, fellowships or other religious or civic
`organizations to which you belong, as well as any leadership positions you have held there:
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`Where do you get most of your news? Television
`Websites
`Social Media
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`Newspapers Magazines
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`Radio
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`Case 6:21-cv-00569-ADA Document 219-1 Filed 06/20/23 Page 4 of 5
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`For the news source listed above, please indicate the network, publication, station or website:
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`Do you have special knowledge, training, education or work experience in any of the following
`areas? (In the chart below, please place a checkmark in the box next to any that are applicable):
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`Patents, copyrights or trademarks
`Law, law firms, court
`system
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`Computer hardware
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`Wi-Fi/Networking
`Electrical engineering
`Consumer electronics
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`Coding/Computer
`Science
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`IT
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`Psychology
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`Software or App development
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`Research and Development
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`Licensing/Business Contracts
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`Electronic streaming media
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`Streaming media providers such as
`Apple, Amazon, Google, Roku, etc.
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`Sales
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`Finance, Accounting, or Economics
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`What are your hobbies and interests? ________________________________________________
`What person do you most admire?___________________________________________________
`Have you ever heard of or are you familiar with the following companies?
`Touchstream Yes No
`Shodogg
`Yes No
`Yes No
`If yes, briefly explain:____________________________________________________________
`Have you or someone close to you ever invented, patented or designed anything?
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`No
`Yes, Someone Else
`Yes, Self
`If “yes”, who invented, patented, or designed it?
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`If “yes,” what was patented, invented, or designed?
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`Have you or someone close to you ever applied for a patent?:
`Yes, Self Yes, Someone Else No
`If “yes,” please describe what was covered by the patent and whether a patent was
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`Case 6:21-cv-00569-ADA Document 219-1 Filed 06/20/23 Page 5 of 5
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`granted:
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`Have you or an immediate family member ever owned a business: Yes No
`If “yes,” please indicate type of business and the years it was owned?
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`Have you or an immediate family member ever been an officer, director, or member of a
`corporation, partnership, or limited liability company? Yes No
`If yes, please describe: ___________________________________________________________
`What is your opinion of large corporations in general? Very Positive
`Somewhat Positive
`Somewhat Negative Very Negative
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`Have you ever owned or operated a Google Chromecast Device: Yes No
`If yes, how often do you use the Google Chromecast Device:
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`Daily Weekly Few times a month Every few months Rarely or never
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`Have you ever owned or operated a video streaming device other than a Google Chromecast
`device (for example, Apple TV, Amazon Fire Stick, Roku)? Yes No Uncertain
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`If yes, how often do you use the video streaming device:
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` Daily Weekly Few times a month Every few months Rarely or never
`Have you ever used any Shodogg or Touchstream product or service? Yes No Uncertain
`Have you ever worked as a juror before: No Yes, in a civil case Yes, in a criminal case
`Yes in both civil and criminal cases
`If “yes,” what kind(s) of case(s)?_____________________________________________
`If “yes,” were you the foreperson? Yes No
`If “yes,” what was the jury’s verdict(s)?___________________________________________
`Do you have any concerns related to COVID-19 that might impact your ability to serve on the
`jury? Yes No
`Do you have an unusual hardship or other personal issue that would affect or prevent your ability
`to serve as a juror in a case scheduled for trial from July 17 to July 21, 2023 in Waco?
`Yes No
`If “yes,” describe hardship.
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