Free United States District Court for the District of South Carolina Application for Mediators - South Carolina

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UNITED STATES DISTRICT COURT DISTRICT OF SOUTH CAROLINA Application for Mediators Please complete the entire application, using additional paper if necessary. You may also attach a resume. Name: Firm or Office Name: Office Address:

Office Phone: email address: _______________________ ADMISSIONS AND AFFILIATIONS Date admitted to the Bar of the District of South Carolina: Date admitted to the South Carolina Bar:

Office Fax:

I.D. No.: Bar No.:

Other courts or jurisdictions to which admitted (with dates of admission and bar nos.):

Membership and positions held in bar, ADR and professional associations:

Are you a member in good standing in each jurisdiction where admitted to practice law? Are you currently the subject of any pending disciplinary proceeding in any jurisdiction?

yes yes

no no

Have you, within the last 5 years, been denied admission to a bar for character or ethical reasons or disciplined for professional misconduct? yes no EDUCATION Year law degree received Law School

Other professional degrees received (including year and school)

LEGAL EXPERIENCE (A minimum of 5 years of law practice required) Summarize legal experience (including teaching) since admission to the bar, particularly in the past five years:

Percentage of practice in last 5 years representing plaintiff

% or defense % State

% %

Percentage of Federal or State court practice in last 5 years: Federal Number of years engaged in active litigation: EXPERTISE

Indicate all substantive areas in which you have expertise. Place a "1" by your strongest area(s) and a "2" by all other areas in which you have expertise. (Do not rank beyond "1" and "2.") After any category you have marked, please identify any sub-areas of expertise you have (e.g. "medical malpractice" after Personal Injury). Admiralty Antitrust Contracts Environment Fraud or Civil RICO Insurance Miller Act Personal Injury Product Liability Other (specify) Publications: Security or Shareholders suits Labor ERISA Wrongful Termination Civil Rights in Employment Other Civil Rights Copyrights Patent Trademark

MEDIATION EXPERIENCE Mediation experience (particularly in the subject matter categories above):

Other courts or organizations for whom you serve as a mediator (please note any certifications):

______________

Number of mediations conducted: MEDIATION AND OTHER ADR TRAINING Course Provider Course Content

Number of other ADR sessions conducted:

______________

Date

Place

No. of Hours

OTHER INFORMATION Are you familiar with the statutes, rules and practice governing alternative dispute resolution in the District of South Carolina? yes no Other relevant experience or skills or other information you would like considered in connection with this application:

Cities in which you are available to conduct mediation: Columbia Other Charleston Greenville Florence

Fees charged: Hourly Rate: $ How do you bill for travel? (explain): Minimum charge each mediation:$

I agree to: (1) Be subject to the Rules of Professional Conduct, Rule 407, South Carolina Appellate Court Rules; the Rules for Lawyer Disciplinary Enforcement, Rule 413, South Carolina Appellate Court Rules; and the Local Rules of the District Court; (2) Provide mediation to indigents without pay if ordered by the Court; (3) Notify the Alternative Dispute Resolution Program Director of any change in the above facts or otherwise in my ability to perform duties as a mediator; (4) Disclosure of information contained in this application to litigants and other members of the public. I certify that the foregoing is true and correct. Signature: Applicant Return completed application to: Danny H. Mullis, Director Alternative Dispute Resolution Program United States District Court Post Office Box 835 Charleston, SC 29402-0835 Reviewed: _________________________________ ADR Program Date: ________________ Date: ________________

Approved: ___________________________________ U.S. District Judge
3/2000

Date: _____________