USCCR SAC Application

Advisory Committee Member Recruitment Application
INTRODUCTION

This application is used as part of the recruitment process for the selection and
appointment of individuals to serve as unpaid members of an Advisory Committee
(Committee) to the United States Commission on Civil Rights (Commission). The
Commission is an independent, bipartisan federal agency that studies civil rights
issues and appraises federal laws and policies relating to discrimination.

The Commission has established an Advisory Committee in every state, the District
of Columbia, and the five U.S. territories. These committees serve as the
Commission’s eyes and ears and advise the Commission about civil rights matters in
their states. Committee members are recruited from a broad cross-section of
professional, educational, and political backgrounds. The Commission is especially
interested in appointing individuals with diverse viewpoints who have a
demonstrated interest in the various civil rights issues that fall within the
Commission’s jurisdiction, as well as individuals who can approach these issues from
diverse personal and professional experiences.
Committee members are required to have an established residence in the state or
territory they are applying to, are appointed to four year terms, and are expected to
make meaningful contributions to the Committee in its development of projects and
creation of reports for the Commission. Committees meet on average every quarter,
but Committees in the midst of a project may meet monthly. Members who miss two
consecutive meetings may be subject to constructive resignation from the
Committee.
Individuals interested in serving and capable of fulfilling the expectations of being
an Advisory Committee member are invited to complete this survey.
NOTE: YOU WILL BE REQUIRED TO UPLOAD A CURRENT RESUME AND PROVIDE A
500 WORD OR LESS STATEMENT ON YOUR EXPERIENCE OR QUALIFICATIONS FOR
APPOINTMENT. PLEASE HAVE THESE PREPARED PRIOR TO STARTING THE
APPLICATION. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED.
For questions about membership on an Advisory Committee or how to complete this
application, contact David Mussatt, Supervisory Chief of Regional Programs at
[email protected] or (312) 353-8311 x 108.

Advisory Committee Member Recruitment Application
GENERAL INFORMATION

* 1. Please provide your name, the address of your primary residence, and your best contact
information:
Name

Address

Address 2

City/Town

State/District/U.S.
Territory

ZIP/Postal Code

Email Address

Phone Number

2. Preferred Name, if different

* 3. For which Advisory Committee are you applying?

* 4. Are you currently a member of this Advisory Committee?
Yes
No

5. If you answered "No" to the previous question, how did you become interested in the U.S.
Commission on Civil Rights and its Advisory Committees?

6. If you answered "Yes" to Question 3, when were you first appointed to the Advisory
Committee? If you answered "No" to Question 3, you may skip this question.

7. If appointed, would you be interested in serving as the Chair of the Committee if so
appointed by the Commission?
Yes
No
Not Sure

8. If you answered yes (or not sure) to Question 6, please provide a brief statement (less than
100 words) about other relevant committees or boards you have previously chaired or other
experiences that you would like to share with the Commission.

Advisory Committee Member Recruitment Application
DEMONSTRATED INTEREST AND EXPERIENCE IN CIVIL RIGHTS

The Commission is especially interested in recruiting individuals who have a
demonstrated interest in civil rights, voting rights and the equal protection under
the law in the administration of justice. Please assist the Commission in evaluating
your demonstrated interest and experience in civil rights by describing your interest
and background in issues pertaining to voting rights; discrimination based upon
color, race, religion, sex, age, disability, national origin; or in the denial of equal
protection under the law in the administration of justice.
* 9. Please describe your interest and experience in civil rights in 500 words or less below.

* 10. Please upload your current resume here: These answers have logic applied

No file chosen

Advisory Committee Member Recruitment Application
EDUCATION AND PROFESSIONAL EXPERIENCE

The Commission hopes to recruit Advisory Committee members with a broad
diversity of skills and experiences, including but not limited to social science
research, legal research and analysis, statistical analysis, and technical writing. The
Commission is also looking for Advisory Committee members who are knowledgeable
about governmental machinery and the public service sector; those who have had
experience in such sectors as business/finance, organized labor, the news media, and
religious groups; or persons who have advocated on civil rights matters. Please
assist the Commission in evaluating your skills and experiences by providing the
following information.
11. What is the highest level of school you have completed or the highest degree you have
received?
Less than high school degree

Masters degree

High school degree or equivalent (e.g., GED)

J.D.

Some college but no degree

Ph.D.

Associate degree

M.D.

Bachelor degree
Other (please specify)

12. Which of the following best describes your current occupation? (Select all that apply)
Advocacy

Organized Labor

Business and Financial Operations Occupations

Public Interest / Non-Profit

Educational Occupations

Religious Group

Government

Social Science Research

Law

Statistical Analysis

News/Media

Technical Writing

Other (please specify)

13. Which of the following best describes your past occupational experiences? (Select all that
apply)
Advocacy

Organized Labor

Business and Financial Operations Occupations

Public Interest / Non-Profit

Educational Occupations

Religious Group

Government

Social Science Research

Law

Statistical Analysis

News/Media

Technical Writing

Other (please specify)

Advisory Committee Member Recruitment Application
POLITICAL AND IDEOLOGICAL IDENTIFICATION

The Commission is a bipartisan federal agency and seeks Advisory Committees that
are bipartisan. Further, the Federal Advisory Committee Act requires that Advisory
Committees are composed of individuals with diverse viewpoints. Please respond to
the following questions to ensure the Commission appoints bipartisan Advisory
Committees that will approach civil rights issues from a diversity of viewpoints.
14. Are you a registered voter?
Yes
No
Unsure / Don’t know

* 15. Generally speaking, do you usually think of yourself as a Republican, a Democrat, an
Independent, or something else?
Republican

Independent

Democrat

Something else

16. If you think of yourself as an Independent, do you think of yourself as closer to the
Republican Party or to the Democratic Party, or equally close to the Republican Party and
Democratic Party?
The Republican Party
The Democratic Party
Equally close to the Republican Party and Democratic Party
I do not think of myself as an Independent

17. If you selected "Something else" to Question 14, please explain. If you did not answer
"Something else" to Question 14, you may skip this question.

18. How would you describe your overall political or philosophical worldview? For example,
you might wish to discuss whether you consider yourself conservative, libertarian, moderate,
liberal and/or progressive, and why. Please keep your answer to 100 words or less.

Advisory Committee Member Recruitment Application
PERSONAL INFORMATION

The demographic information on this page is requested on a voluntary
basis and only for record-keeping purposes. The answers to these
questions will not be used as a basis for selecting members.
19. Which race/ethnicity best describes you?
American Indian or Alaskan Native

White or Caucasian

Asian or Asian American

Native Hawaiian or other Pacific Islander

Black or African American

Prefer not to answer

Hispanic or Latino
Multiple ethnicity / Other (please specify)

20. Do you identify as Mexican, Mexican-American, Chicano, Puerto Rican, Cuban, CubanAmerican, or some other Spanish, Hispanic, or Latino group?
I am not Spanish, Hispanic, or Latino

Cuban

Mexican

Cuban-American

Mexican-American

Some other Spanish, Hispanic, or Latino group

Chicano

From multiple Spanish, Hispanic, or Latino
groups

Puerto Rican

Prefer not to answer

21. How do you describe your sexual orientation?

22. In what languages can you speak fluently or are a native speaker?
Arabic

Japanese

Armenian

Korean

Chinese

Persian

English

Polish

French

Portuguese

French Creole

Russian

First Nations

Spanish

German

Tagalog

Greek

Urdu

Gujarati

Vietnamese

Hindi

Prefer not to answer

Italian
Other (please specify)

23. In what year were you born? (enter 4-digit birth year; for example, 1976 or type "Prefer
not to answer")

24. How do you describe your ability status?
A sensory impairment (vision or hearing)
A learning disability (e.g., ADHD, dyslexia)
A long-term medical illness (e.g., epilepsy, cystic fibrosis)
A mobility impairment
A mental health disorder
A temporary impairment due to illness or injury
A disability not listed above
I do not identify with a disability or impairment
Prefer not to answer

25. What is your present religion, if any? (Please select all that apply.)
Protestant

Hindu

Roman Catholic

Sikh

Mormon

Inter/Non-denominational

Orthodox, such as Greek or Russian Orthodox

Atheist

Jewish

Agnostic

Muslim

No religion

Buddhist

Prefer not to answer

A religion not list (please write in comment box)

26. Have you ever served in any branch of the United States military?
Yes, I have
No, I have not

Advisory Committee Member Recruitment Application
Professional Works and other Online Content

27. Do you publish any writings in journals or elsewhere (such as a blog)? If so, please
provide a list of those publications.

28. Are you active on social media platforms, such as Facebook, Twitter, Instagram, etc? If so,
please provide your handles on those platforms.

29. Is there any additional information you think the the Commission should know that would
impact your candidacy, or that could adversely reflect on the Commission if it were to become
public?

Advisory Committee Member Recruitment Application
PRIVACY NOTICE

The Privacy Act of 1974 requires that when we ask you for information about
yourself, we state our legal right to do so, tell you why we are asking for it, and how
it will be used. We must also tell you what could happen if we do not receive it, and
whether your response is voluntary, required to obtain a benefit, or mandatory.
Supplying the information is voluntary and not directly required by law. The U.S.
Commission on Civil Rights is requesting the information on this application in
order to facilitate the processing of your application to be an advisory committee
member.