Free Mediator Application - Idaho


File Size: 4.9 kB
Pages: 2
Date: October 21, 2002
File Format: PDF
State: Idaho
Category: Court Forms - Federal
Author: tom
Word Count: 167 Words, 1,390 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.id.uscourts.gov/docs/MediatorApplication.pdf

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UNITED STATES DISTRICT AND BANKRUPTCY COURT FOR THE DISTRICT OF IDAHO
550 West Fort Street Boise, Idaho 83724

MEDIATOR APPLICATION
TO: Denise Asper, ADR Program Coordinator U.S. District Court, District of Idaho MSC 039, 550 West Fort Street Boise, ID 83724 (208) 334-9067 Fax: (208) 334-9215

APPLICANT:_________________________________________________________

Address:_____________________________________________________ _____________________________________________________________

Telephone:________________________Fax:_______________________ E-Mail:______________________________________________________

(1)

Date of admission to practice law and years practiced:

(2)

Professional Affiliations and Membership: (i.e., Bar membership(s), ADR associations, etc.)

(3)

Mediation Training:

Hours of Training: Name of institution(s), college(s), or Date: trainer(s), content of course(s): _____________________________________________________________________

(4)

Fees: (Do you include expenses?)

I am applying to be on the Mediator Roster. I have never been disciplined in any fashion at any time for any action or inaction related to the practice of law or the providing of ADR services and I certify that the above is true and correct. I authorize the federal court to verify any of the above information. Date: ___________________________________________ Applicant Signature