Michigan > Statewide > Civil > General
Civil Mediator Application MC 281A - Michigan
| Civil Mediator Application Form. This is a Michigan form and can be used in General Civil Statewide . |
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Approved, SCAO CIVIL MEDIATOR APPLICATION To be eligible to serve as a general civil mediator, you must meet the training and experience criteria specified either in MCR 2.411(F)(2) or in the SCAO Mediation Training Standards and Procedures pursuant to MCR 2.411(F)(3). Service as a case evaluator under MCR 2.403 does not constitute a qualification for serving as a mediator. Refer to the Mediation Training Standards and Procedures for further information about minimum qualifications. Note: Except for Part B, the information provided in this application is available to the public for inspection. Please type or print neatly. 1. Full name (first, middle initial, last) 3. Address where you can be contacted 4. Telephone no. 5. Fax no. 6. E-mail address 2. Bar no. if applicable P Part A: General Civil Mediator Qualifications Complete item 7 and either item 8, 9, 10, 11, or 12 as appropriate. 7. 8. Is this a new application? renewal? If renewing, complete item 12 and attach a copy of your original application. Qualification through State Court Administrative Office (SCAO) Approved Training a. SCAO approved training completed on Date . Attach copy of certificate. Trainer: b. Juris doctorate Attach copy of diploma if not a licensed attorney. Attach copy of diploma. Detail below. Complete Graduate degree in conflict resolution 40 hours of mediation, observation, or role playing experience over 2 years before applying. on separate page if needed. c. Observed 2 general civil mediation proceedings. Specify dates and mediator names and attach verification. Do not provide party names. d. Conducted 1 general civil mediation to conclusion. not provide party names. Specify date and name of mediator serving as supervisor and attach verification. Do 9. Qualification by Community Dispute Resolution Program (CDRP) Training a. Michigan CDRP training completed on Date . Attach copy of certificate. Trainer: If the training was completed more than 2 years before applying, applicant must have completed 8 hours of advance mediation training in the 2 years before applying. Specify type of training, dates, and trainers, and attach copy of certificate. MC 281a (3/06) continued on page 2 CIVIL MEDIATOR APPLICATION, Page 1 of 4 MCR 2.411(E) American LegalNet, Inc. www.FormsWorkflow.com Civil Mediator Application, continued from page 1 Part A: General Civil Mediator Qualifications (continued) 9. b. Observed 2 general civil mediation proceedings. Specify dates and mediator names and attach verification. Do not provide party names. c. Conducted 1 general civil mediation to conclusion. not provide party names. Specify date and name of mediator serving as supervisor and attach verification. Do d. If not an attorney or a person holding a juris doctorate or graduate degree in conflict resolution, applicant must have mediated at least 40 hours or 18 cases in the 2 years before applying. Detail below. Complete on separate page if needed. Do not provide party names. e. As a non-Michigan licensed lawyer/nonlawyer, completed on Date , a 6-hour program addressing basic Michigan laws, rules, and guidelines governing civil actions. Instructor: 10. Qualification by Training Outside of Michigan a. Completed a comprehensive training course of at least 40 hours designed for general civil case mediation. Attached are: 1) a certificate of completed training; 2) a copy of the training agenda; 3) the name of the trainer; 4) the date of the training; and 5) the dates of attendance. b. If the training was completed more than 2 years before applying, applicant must have completed at least 8 hours of advanced mediation training in the 2 years before applying. Specify type of training, dates, and trainers, and attach copy of certificate. c. Observed 2 general civil mediation proceedings. Specify dates and mediator names and attach verification. Do not provide party names. d. Conducted 1 general civil mediation to conclusion. not provide party names. Specify date and name of mediator serving as supervisor and attach verification. Do e. If not an attorney or a person holding a juris doctorate or graduate degree in conflict resolution, applicant must have mediated at least 40 hours or 18 cases in the 2 years before applying. Detail below. Complete on separate page if needed. Do not provide party names. f. As a non-Michigan licensed lawyer/nonlawyer, completed on Date , a 6-hour program addressing basic Michigan laws, rules, and guidelines governing civil actions. Instructor: continued on page 3 MC 281a (3/06) CIVIL MEDIATOR APPLICATION, Page 2 of 4 MCR 2.411(E) American LegalNet, Inc. www.FormsWorkflow.com Civil Mediator Application, continued from page 2 Part A: General Civil Mediator Qualifications (continued) 11. Other Qualification Complete items 11a or 11b and 11c through 11e. a. Voluntary Facilitative Mediation Program Training - Completed a minimum 16-hour program before January 1, 2003. Attach copy of certificate and copy of training agenda. Specify the name of the trainer and dates of attendance. b. Circuit Court Mediation - Completed a minimum 16-hour mediation training program and supplemental 8-hour program related to the training components of Section 2.1 completed before December 31, 2001. Attach copy of certificate and copy of training agenda. Specify the name of the trainer and dates of attendance. c. Observed 2 general civil mediation proceedings. Specify dates and mediator names and attach verification. Do not provide party names. d. Conducted 1 general civil mediation to conclusion. not provide party names. Specify date and name of mediator serving as supervisor and attach verification. Do e. If not an attorney, applicant must have mediated at least 40 hours or 18 cases in the 2 years before applying. Detail below. Complete on separate page if needed. Do not provide party names. f. If the training was completed more than 2 years before applying, appilcant must have completed 8 hours of advanced mediation training in the 2 years before applying. Specify type of training, dates, and trainers, and attach copy of certificate. 12. Renewing Application If the mediation training was completed more than 2 years before applying, the applicant must have completed 8 hours of advanced mediation training in the 2 years before applying. Specify type of training, dates, and trainers, and attach copy of certificate. CERTIFICATION I certify that I: a) meet the requirements for service under the court's mediator selection plan; b) will no
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