Texas > Federal > District Court > Western District
Application To Become Approved Mediator (Austin Division Only) - Texas
| Application To Become Approved Mediator (Austin Division Only) Form. This is a Texas form and can be used in Western District District Court Federal . |
|
||||||
 Get this form for FREE as a print-only pdf |
|||||||
|
UNITED STATES DISTRICT COURT WESTERN DISTRICT OF TEXAS AUSTIN DIVISION APPLICATION TO BECOME APPROVED MEDIATOR NAME: FIRM OR ORGANIZATION: STREET ADDRESS: CITY, STATE, ZIP: TELEPHONE: EMAIL ADDRESS: 1. No Are you a member of the Bar of the Western District of Texas? ____________________ , FAX: Date of admission: __________________ 2. State Bar ID No.: ____________________ No Are you a faculty member of an accredited Texas law school? _____________________ Name of school: ___________________________________________________ 2. Please list states/courts in which you are admitted to practice and dates of admission: 3. Have you ever been subject to any disciplinary action, sanction, contempt order, or No reprimand by any court, Bar, or judicial administration body? ___________________ If yes, provide details on separate sheet. 4. Please describe any formal training you have received in mediation or other forms of Alternative Dispute Resolution. Please include the dates of the training, the sponsor, and whether the training qualified for Texas MCLE credit. Attach additional sheets if necessary. Type of Training Dates No./Hrs. Sponsor MCLE Credit T X W D - AU S - M ediator Application (Rev. 05/2007) American LegalNet, Inc. www.FormsWorkFlow.com 5. Please describe the extent and nature of your experience as a mediator, including approval/certification by other jurisdictions or agencies. 6. Please check all applicable areas of substantive experience: Administrative Corporate Personal Injury Bankruptcy Environmental Real Property Civil Rights Insurance Securities Constitutional Intellectual Property Contracts Other (describe): Please submit this application, a current resume or curriculum vitae, and a certificate of good standing from the Supreme Court of Texas to: David O'Toole, Divisional Office Manager United States District Court, Western District of Texas Austin Division 501 West Fifth Street Austin, Texas 78701 "I hereby affirm that the information provided above is true and correct. I understand that my completed application may be made available by the Clerk of Court to litigants or counsel seeking information about my experience." Applicant Signature: Date: T X W D - AU S - M ediator Application (Rev. 05/2007) American LegalNet, Inc. www.FormsWorkFlow.com
|
|||||||
