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Application For Admission To Roster Of Mediators- Economic Aspects Family Law (W-Instructions) 10488 - New Jersey

Application For Admission To Roster Of Mediators- Economic Aspects Family Law (W-Instructions) Form. This is a New Jersey form and can be used in Family Practice Statewide .
 Fillable pdf Last Modified 10/6/2015
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Criteria for Admission to the Roster of Mediators for Economic Aspects of Family Law Cases Mediation Training Successful completion of 40 hours of mediation training approved by the Joint Credentials Committee, or completion of a minimum of 25 hours of mediation training and an additional 15 hours within one year after admission to the roster. Education/ Professional Experience 1. a. Juris Doctor (or equivalent law degree); b. Admission to the Bar for at least seven years; c. Licensed to practice law in the state of New Jersey; and d. Practice substantially devoted to matrimonial law. or 2. a. Advanced Degree in Psychology, Psychiatry, Social Work or allied Mental Health field, Business, Finance, or Accounting, or a CPA; b. At least seven years experience in the field of expertise; and c. Licensed in New Jersey if required in the field of expertise. Annual Continuing Education Following completion of the total requirement of 40 hours mediation training, attendance at a minimum of four hours of annual continuing education as set forth under Rule 1:40-12(b)(2). Application Review Process Applications will be reviewed by a Joint Credentials Committee of the Supreme Court Committee on Complementary Dispute Resolution and the Supreme Court Family Practice Committee. Please Include Copies of Training Certificates Revised: 08/19/2015: CN: 10488 American LegalNet, Inc. Save Form Print Form Clear Form New Jersey Judiciary Application for Admission to Roster of Mediators for Economic Aspects of Family Law Cases Last Name Firm / Business Name Firm / Business Address City Degrees Attained (Post High School) State Year Zip Code Telephone Number Area of Concentration Fax Number First Name Middle Name Name of Institution Professional License(s): Specify Type and When Obtained Have You Ever Been Disciplined In Your Profession? (If Yes, Attach Explanation) Year of Admission to Professional Practice Number of Years of Experience Bar Admission Year New Jersey: Other States: Yes No Certified Matrimonial Attorney Primary Counties of Practice For Attorneys: Percent of Practice Devoted to Matrimonial Law For Non-Attorneys: Percent of Time Devoted to Family Matters Yes No Primary Counties of Practice Mediation Training (attach additional sheet if necessary) Provider(s) Course Title Date(s) Hours Number of Years Doing Mediation Number of Mediations in Past 5 Years Hourly Fee Do You Have Malpractice Insurance? $ Yes No I certify that the foregoing statements made by me are true and that I am in good standing in my profession. Date Signature Please attach the following: 1. Resume or Curriculum Vitae 2. Description of mediation training courses 3. Descriptive paragraph (please provide a maximum of 50 words about your mediation and other relevant professional experience that will be transferred directly to the roster if you are accepted) 4. Subject area(s) of mediation experience 5. List of professional organizations in which you are an active member. Return the above five items and this form to: Joanne M. Dietrich Family Division Administrative Office of the Courts PO Box 983 Trenton, NJ 08625 Revised: 08/19/2015: CN: 10488 American LegalNet, Inc.
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