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ADR Panel Application - Rhode Island

ADR Panel Application Form. This is a Rhode Island form and can be used in District Court Federal .
 Fillable pdf Last Modified 1/7/2009
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UNITED ST ATES DISTRI CT COURT DISTRICT O F RHODE ISLAND ADR PANEL APPLICATION Please complete the entire application, using additional paper if necessary. You may also attacha resume, however, you must complete and return this application. Name: Firm or Office Name: Office Address:_________________________________________________________________ Office Phone: Office Fax:___________________________E-mail______________________________ ADMISSIO NS AND AFFIL IATIONS Date admitted to the Federal Bar, District of Rhode Island: I.D. No. Date admitted to the Rhode Island Bar: Bar No.: Other courts or jurisdictions to which admitted (with dates of admission and bar nos.): Membership and positions held in bar, ADR and professional associations: Are you a member in good standing in each jurisdiction where admitted to practice law? yes no Are you currently the subject of any pending disciplinary proceeding in any jurisdiction? yes no Have you ever been denied admission to a bar for character or ethical reasons or disciplined forprofessional misconduct? yes no 1 <<<<<<<<<********>>>>>>>>>>>>> 2EDUCATION Year law degree received Law School: Other professional degrees received (including year and school)__________________________Other education_________________________________________________________________LEGAL EXPERIENCE (A minimum of 10 years of law practice required)Summarize legal experience since admission to the bar: Percentage of practice in last 5 years representing plaintiff % or defense %Percentage of federal or state court practice in last 5 years: Federal % State %Number of years engaged in active litigation: EXPERTISE Indicate all substantive areas in which you have legal or other expertise:___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Publications: 2<<<<<<<<<********>>>>>>>>>>>>> 3ADR TRAINING & EXPERIE NCE Describe your experience and training in ADR. Also, indicate any ADR certifications you hold,when they were awarded and by whom. Other courts or organizations for whom you serve as an ADR panel member or neutral mediator:OTHER INFORMATION Please describe any other information, knowledge or skills you wish to be considered as part ofthis application. CERTIFICAT ION: I am making application to serve on the ADR Panel for District of Rhode Island and certify thatthe foregoing is true and correct. Signature Date 20__ Return completed application to: Berry B. Mitchell Office of Alternative Dispute Resolution United States District Court 2 Exchange Terrace, Room 104 Providence, RI 02903 Form: ADR Panel Application (September 25, 2001) 3
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