Free Report of Bi-Annual Compliance for Mediators - Oklahoma

UNITED STATES DISTRICT COURT WESTERN DISTRICT OF OKLAHOMA REPORT OF BI-ANNUAL COMPLIANCE* OF REQUIREMENTS FOR CONTINUATION ON THE PANEL OF MEDIATORS
I, (print or type name) , confirm that I have satisfied the requirements of General Order 00-2 (E) of the U.S. District Court for the Western District of Oklahoma, Regarding Court-Appointed Federal Panels by (check the appropriate box(es): completing a minimum or six (6) hours of continuing professional education in the area of mediation, which education has been approved by the MCLE Commission of the Oklahoma Bar Association or other CLE approving agency or organization - attach proof of attendance; or

9

9completing at least six (6) mediation sessions as a mediator - attach list of mediations with names of
attendees; and

9

sending written confirmation of satisfying this requirement to the ADR Administrator.

Other information concerning training courses and /or mediations completed as a mediator:

Date

___________________________________________ Signature

I, (print or type name)

,

9

have not met the additional training requirements nor the required number of mediation session requirements as a mediator and, therefore, request removal from the current roster of mediators; or

9 request removal from the current roster of mediators;
or

9 request a waiver due to special circumstances and wish to continue listing if approved. ( Please enclose a statement for the ADR Advisory Committee's review.)
* Required every 2 years (even years) ___________________________________________ Signature

Date

Please Return To: Marcia J. Davis, ADR Administrator U.S. District Court 200 N. W. 4th Street Oklahoma City, OK 73102