Judicial Branch of California

Family Division ADR Panel Background Information

Mediators currently in the Family ADR database and who need to update their provider information can do so by filling out this online form.

Name:

Firm Name:

Address:

County:

Phone Number:

Email Address:

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Check each panel for which you are applying:

Mediation

Collaborative Practice

1. Describe your education, including degrees and the dates received.

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Education/Degree Description	Date Received
Education/Degree Description	Date Received

2. Briefly describe the ADR training you have received. For each training, give the trainer's name, the dates attended, and the total hours.

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ADR Training Description	Trainer's Name	Date Attended	Total Hours
ADR Training Description	Trainer's Name	Date Attended	Total Hours

3. Describe the subject matter of five disputes for which you have been a mediator in the past five years, with the dates. State whether you were a sole- or co-provider.

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Describe the Subject Matter of Dispute	Date	Sole- or Co-Provider
Describe the Subject Matter of Dispute	Date	Sole- or Co-Provider

5. What is your State Bar No.?

a. How many years have you been in active practice? In none, please explain.

b. What is or was the nature of your practice?

c. Are you certified in any specialty? If so, please list.

6. What is your ADR style?

7. Describe your fee schedule, including any sliding-scale or pro-bono provisions.

8. Give any other information that should be considered by parties or counsel.

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