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ADR Demographic Information Confidential ADR 011 - California
| ADR Demographic Information Confidential Form. This is a California form and can be used in Alternative Dispute Resolution Los Angeles Local County . |
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SUPERIOR COURT OF CALIFORNIA, COUNTY OF LOS ANGELES ALTERNATIVE DISPUTE RESOLUTION (ADR) DEMOGRAPHIC INFORMATION JOHN A. CLARKE, EXECUTIVE OFFICER/CLERK ALTERNATIVE DISPUTE RESOLUTION (ADR) DEPARTMENT The provision of Court ADR services is made possible through major support from the Los Angeles County Department of Community and Senior Services through the California Dispute Resolution Program Act. As part of the funding requirements, the collection of demographic information is required. All information is confidential. I. Disputant Description Self-Representing: Business Individual/Self Insurance Company Other Attorney Representing: Business Government Entity Individual/Self Insurance Company Other II. Disputant Frequency First Time Client Repeat Client Unknown III. Gender Male Female N/A (business, organizations, etc.) IV. Age 17 and Under 18 - 39 40 - 64 65 and over Declined to State N/A (business, organizations, etc.) V. Supervisorial District of Residence/Business/ Organization Supervisorial District 1 Gloria Molina Supervisorial District 2 Mark Ridley-Thomas Supervisorial District 3 Zev Yaroslavsky Supervisorial District 4 Don Knabe Supervisorial District 5 Mike Antonovich Outside of LA County VI. Self-Identified Ethnicity American Indian/Native Alaskan Asian/Pacific Islander Black/African-American Hispanic/Latino White Multiple Ethnicities/Races Other Declined to State N/A (businesses, organizations, etc.) VII. Self-Identified Primary Language Armenian Cambodian Chinese English Farsi Korean Russian Spanish Tagalog Vietnamese Other Declined to State N/A (businesses, organization, etc.) VIII. Self-Identified Annual Household/Business Income $20,000 or less $20,001-$30,000 $30,001-$50,000 $50,001 and Over Declined to State N/A (businesses, organizations, etc.) IX. Self-Identified Disability Status*(participants must self-identify; inquiring outside of self-identification may violate certain laws) Yes No Declined to State N/A (businesses, organizations, etc.) LAADR 011 (Rev. 01-12) LASC Adopted 11-03 For Mandatory Use ALTERNATIVE DISPUTE RESOLUTION (ADR) DEMOGRAPHIC INFORMATION American LegalNet, Inc. www.FormsWorkFlow.com Cal. DRPA Statutes and Regulations, §§ 467.6 & 471.5 Local Rules, rule 3.255 Page 1 of 1
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