Kgi Jury Duty Summons
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1JURY DUTY SUMMONS
Complete and sign the form below; you signature is required.
Please allow 2‐3 business days for processing; please send in your request as early as possible to give enough time
to process your Jury Duty Letter.
You must complete your portion of the Jury Summons.
You must attach the summons to this form and submit both to the Office of the Registrar.
Name (please print): ____________________________
Daytime Phone: ______________________
Student ID (or SSN): ____________
Program: _____________
Graduation Year: _______________
Special Instructions:
Please process my request immediately; send my Federal Express ‐ $25.00 (Please attach check to the
form. The check should be make out to Keck Graduate Institute.)
Other ___________________________________________________________________________
My scheduled appearance date is less than 3 days: please process my letter immediately.
Notice to Students: To ensure that you are not “Held in Contempt of Court” for not showing up to jury duty on
your scheduled date, you may be required to hand carry the letter to the respective courthouse to request a
postponement.
** Completion of this request does not guarantee excusal from jury duty.
Please refer to the return envelope provided as well as your Summons for the following:
_____________________________
Juror ID Number: ______________
Court Name
_____________________________
Street Address
_____________________________
_____________________________
City, State, Zip
With my signature I hereby authorize the release of the requested document(s) to the above
person/organization:
Signature (required)
Date ____________
An Electronic Signature is not valid
KGI OFFICE USE
Date Received:
Date Processed:
Initial
August 2015, KGI Registrar’s Office
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