Fill and Sign the Civil Training Application Formdoc

Superior Court of the District of Columbia Multi-Door Dispute Resolution Division Civil Dispute Resolution Program Mediator Application (Please print clearly) Daytime Name Phone Evening Address Phone Date of Birth E-Mail City State Zip Code Current Employment / Occupation: Position / Title: Legal Background & Experience: Year Admitted to D.C. Bar: Bar Number: Year Admitted to Practice (if different): Jurisdiction: Number of civil trials completed: Trials in D. C. Superior Court? AREAS OF SIGNIFICANT LEGAL EXPERIENCE (check all that apply): Administrative Law Commercial Transactions Mental Health Automobile Domestic Relations Personal Injury/Negligence Civil Rights Employment Product Liability Collection Ethics Probate Corporations/Partnerships Insurance Real Estate Criminal Legal Malpractice Securities Law Construction Landlord/Tenant Services Rendered Contracts (general) Medical Malpractice Tax Torts (general) Community Activities: (Please list major community / volunteer activities only) Organization(s) Years Active It is our policy to accept volunteers based on qualifications and merit \ only, without regard to race, color, religion, sex, age, d isabilities, national origin, marital status, personal appearance, sexua\ l orientation, family responsibilities, matriculation, political affiliation, source of income, or place of resi\ dence or business. Please provide the following information: Sex: Female Male Race: African American Caucasian Hispanic Asian Dispute Resolution Training & Experience: Please provide details (n ame of program, place, year) of any dispute resolution training(s) or\ experience (mediation, arbitration, case evaluation) you have had, at \ D.C. Superior Court or elsewhere. If you have mediated cases previously, please indicate the a\ pproximate number for which you have been personally responsible as a mediator: . Program(s) Year(s) Experience: From To Which days/times would you prefer for trainings to be scheduled? Please note that trainings may need to be scheduled on a variety of days and times. Weekdays: Monday thru Friday, 8:30 a.m. to 5:00 p.m. Weekdays evenings: Monday thru Friday, after 6:00 p.m. Weekend days: Saturday s Sundays Program Commitment By my signature below, I acknowledge that if I am accepted into a Multi -Door training program, I will be required to make a firm commitment to the Superior Court of the \ District of Columbia. During the ye ar immediately following successful completion of training, I agree to a\ ccept the assignment of no fewer than twenty (20) civil division cases for which\ I will serve as mediator or neutral case evaluator; or to accept the assignment of no fewer than eig\ hte en (18) civil division cases for which I will serve as arbitrator. Signature Date (Invitation to a particular screening session or training class cannot \ be guaranteed. Please refer to the enclosed information.) Please return this form to: Heather Schofield Multi-Door Dispute Resolution Division D.C. Superior Court 515 5th Street, N.W., Suite 105 Washington, D.C. 20001 Phone: 202 -879 -1549 Plea se keep a copy of this application for your records and, as necessary, u\ pdate our office with any changes in your contact information. Thank you. (Rev.12/06)