Free Application for Admission To Roster Of Mediators for Economic Aspects of Family Law Cases - New Jersey

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 . b . c . d . or 2 ) a . b . c . Advanced Degree in Psychology, Psychiatry, Social Work or allied Mental Health field, Business, Finance, or Accounting, or a CPA; At least seven years experience in the field of expertise; and Licensed in New Jersey if required in the field of expertise. Juris Doctor (or equivalent law degree); Admission to the Bar for at least seven years; Licensed to practice law in the state of New Jersey; and Practice substantially devoted to matrimonial law.

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 1:40-10(b) 3.1.

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 06/21/2004, CN 10488-English

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Print Form

Clear Form

APPLICATION FOR ADMISSION TO ROSTER OF MEDIATORS FOR ECONOMIC ASPECTS OF FAMILY LAW CASES
LAST NAME FIRST NAME MIDDLE NAME

FIRM / BUSINESS NAME

FIRM / BUSINESS ADDRESS

CITY

STATE

ZIP CODE

TELEPHONE NUMBER

FAX NUMBER

(
DEGREES ATTAINED (post high school) NAME OF INSTITUTION YEAR

)

-

(

)

-

AREA OF CONCENTRATION

PROFESSIONAL LICENSE(S) (specify type and when obtained) YEAR OF ADMISSION TO PROFESSIONAL PRACTICE NUMBER OF YEARS OF EXPERIENCE PRIMARY COUNTIES OF PRACTICE BAR ADMISSION YEAR NEW JERSEY: _________ OTHER STATES: _________

HAVE YOU EVER BEEN DISCIPLINED IN YOUR PROFESSION FOR ATTORNEYS: PERCENT OF PRACTICE DEVOTED TO MATRIMONIAL LAW FOR NON-ATTORNEYS: PERCENT OF TIME DEVOTED TO FAMILY MATTERS

YES NO (if yes, attach explanation)

CERTIFIED MATRIMONIAL ATTORNEY YES PRIMARY COUNTIES OF PRACTICE

NO

MEDIATION TRAINING (attach addtional 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.

SIGNATURE

Please attach the following: 1. 2. 3. 4. 5. Resume or Curriculum Vitae Description of mediation training courses 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) Subject area(s) of mediation experience List of professional organizations in which you are an active member. Harry T. Cassidy Family Division Administrative Office of the Courts PO Box 983 Trenton, NJ 08625
6

Return the above five items and this form to:

Revised 06/21/2004, CN 10488-English

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