Free NOTICE TO THE BAR - New Jersey

New Jersey Administrative Office of the Courts P.O. Box 983 Trenton, NJ 08625 (609) 984-4228 Application For Registration As A Parenting Coordinator
Name Organization Mailing Address City Telephone ( Email Address ) County Extension State Fax (

For Office Use Only

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The information you furnish above will be used in all correspondence with you and in the Supreme Court's list of parenting coordinators.

I herewith apply for registration on the list of Parenting Coordinators maintained by the Administrative Office of the Courts. In support of this application, I state the following: I am licensed or certified as a by the state of .

(Attach a copy of current professional license or certificate)

I have completed the required training for Family Mediation pursuant to R.1:40-12(5) I have read and am familiar with the appended procedures of Appointment of Parenting Coordinator in Child Custody and Parenting Time Disputes. I have attached a 50 word synopsis of my professional experience and fee schedule. I understand this will be posted on the roster for public view. I agree to maintain adequate records for purposes of quality control and to provide statistical information as required by the Administrative Office of the Courts. I certify that the foregoing statements made by me are true and that I am in good standing in my profession Signature:________________________________________Date:__________________

Published: 04/2007, CN: 10881-English

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