UNITED STATES COURT OF APPEALS
FOR THE SEVENTH
CIRCUIT
VOLUNTEER PANEL ATTORNEY QUESTIONNAIRE
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
U. S. Court of Appeals
219 South Dearborn Street, #2722
Chicago, IL 60604