UNITED STATES COURT OF APPEALS 1. Name
_________________________________________ 2. Address
_______________________________________
___________________________________________________
___________________________________________________ 3. Telephone
_____________________________________ 4. Social Security Number or Federal
Employer Identification Number (necessary for tax purposes on vouchers in
Criminal Justice Act cases only)
____________________________________ 5. Bar Admissions:
_________________________________
___________________________________________________
___________________________________________________ 6. Law school attended and Date of Degree 7. Type of practice:
________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________ 8. Are you currently a member of a panel
maintained by a district court or Federal Public Defender office for
appointment in district court proceedings? If "yes", please
specify. ___________________________________________________________
___________________________________________________________ ____ I am interested in accepting
Criminal Justice Act appointments from the Court of Appeals, under the
guidelines set forth in the Act and the Seventh Circuit Plan for
implementation of the Act. I will accept appointment in 28 U.S.C.
2254 and 2255 appeals and in appeals in criminal proceedings from the
following state(s): ____Illinois ____ I am interested in accepting
appointment in non-Criminal Justice Act appeals, understanding that there
is no statutory authority for the court to compensate me for my time and
expenses. I will accept appointment in the
following types of non-Criminal Justice Act appeals: ____ non-prisoner civil rights ____ EEOC Signature
____________________________________Date_______________
Please return questionnaire to: Donald
J. Wall, Counsel to the Circuit Executive |