Alabama > Appellate > Appellate Mediation Program
Mediator Application 1 - Alabama
| Mediator Application Form. This is a Alabama form and can be used in Appellate Mediation Program Appellate . |
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(Form 1) Appellate Mediation Program Mediator Application PLEASE PRINT OR TYPE APPLICATION Name: ________________________________________Firm or Agency: ___________________________ Street or P.O. Box: ______________________________City/Town: _______________________________ County: _______________________________________Zip Code: ________________________________ Phone: ________________________________________Fax No: __________________________________ E-mail: ________________________________________State Bar No: ______________________________ 1. Have you completed the Alabama appellate mediation training? If so, please attach a copy of your certificate. 2. List the types of mediation training in which you are registered and the dates you received the training. 3. Describe the subject matter of disputes, if any, for which you have been a mediator in the past five years, with the dates. Do not give the names of the parties. State whether you were a sole mediator or a co-mediator. 4. State the name of any organization for which you have provided mediation services during the past five years. 5. Check your areas of substantive expertise: [ ] Administrative agencies [ ] Environment [ ] Probate [ ] Attorney fees [ ] Family law [ ] Products liability [ ] Business/Contract [ ] Health care [ ] Professional negligence [ ] Construction [ ] Housing [ ] Public entity [ ] Corporate [ ] Insurance [ ] Real estate [ ] Defamation [ ] Intellectual property [ ] Securities [ ] Domestic violence [ [ ] Eminent domain [ ] Medical malpractice [ ] Wrongful death [ ] Employment/Labor [ ] Personal injury Other (specify): Mediator Application p.1 <<<<<<<<<********>>>>>>>>>>>>> 26. What is your fee for mediation? 7. How many years have you been in active practice? If none, please explain. 8. What is or was the nature of your practice? 9. Are you certified in any speciality? If so, please list. 10. What percentage of your practice has been representing plaintiffs? ______ defendants? ______11. Describe your appellate experience. 12. Have you mediated an appellate case? Please state when, where, and the type of case mediated. 13. Is your mediation style facilitative or evaluative? Please explain. 14. Please state any restrictions on your ability to travel throughout the State of Alabama. 15. Would you be willing to conduct a mediation by telephone conference if necessary? _____ Yes _____No 16. List any languages, other than English, in which you can conduct a mediation. Mediator Application p.2 <<<<<<<<<********>>>>>>>>>>>>> 3Please read and sign the following agreement: I agree to be bound by the Alabama Supreme Courts Appellate Mediation Rules. I agree to waive any and all claims against the appellate court in connection with my mediation of any court-referred dispute. I agree to mediate pro bono two cases each year. I agree to adhere to the Alabama Code of Ethics for Mediators.Signature: ___________________________________Date: _______________________________________Mail this application to: Appellate Mediation Office ATTN: Michele Walters Alabama Supreme Court 300 Dexter Avenue Montgomery, Alabama 36104Mediator Application p.3
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