Office of Equal Opportunity

Citizen Application For Appointment
The Dane County Equal Opportunity Commission
Criminal Justice Task Force

ALL INFORMATION ON THIS FORM IS PUBLIC RECORD
Please return to:
Isadore Knox, Jr.
Office of Equal Opportunity
Dane County Executive Office
210 Martin Luther King Jr. Blvd. Rm. 421
Madison, Wisconsin 53713
www.co.dane.wi.us

Application submission deadline: August 18, 2008

Please print clearly.
Name:
(Last) (First) (MI)
Home Address:
Home Phone #:    City, Village, or Town:    Zip:
Employer:
Occupation:
Business Address:
Business Phone #:    Email:

Affirmative Action Data: (Please check one)
Race / Ethnicity:      Amer. Indian / Alaskan Native      Asian / Pacific Is.
     Black      Latino      White
Gender:      Male      Female

1. What education, training or knowledge do you possess that uniquely qualifies you for an appointment to the Criminal Justice Task Force?
2. Describe any work or other experience in criminal justice/social justice that would benefit the Criminal Justice Task Force.
3. Please describe why you feel this task force is important to Dane County and what you would like to see accomplished by serving on the task force.
4. Please check below the appropriate categories that would apply to you as it relates to this task force.
Stakeholder Group:
 Advocacy Agency
 Community Partner
 Criminal Justice
 Practicioner
Area of Expertise:

 Community Support Agency

 Criminal Justice Research

 Elected Official

 Ex-Offender

 Juvenile Services

 Justice System (Courts / Prosecutors / Court Programs)

 Law Enforcement (Police, Sheriff, Corrections)

 Mental Health / AODA Services

 Other    



Revised: August 15, 2008