ADR Program Panelist Application {ADR-10}

Form ADR-10 [Rev. May 2019]001001001001001002003004005006007b006001tb003006n001b013001tfr007013b006016007f017001tb003016n020001b013001002f016001021fn005b001021003rn007001b004n007b016001f022006001004006b023005tn001024frr001b013001023003002n007t005001f016022001006005tb006022002001025026026001tb003016n020001t005016n005006001006005022027bb022001t007n020017001tfr007013b006016007f001030025026031032001001001 Instructions for ADR Program Panelist Application Thank you for your interest in San Mateo Superior Court222s Civil and/or Probate ADR Program. The ADR Program Advisory Committee, which includes representatives of the San Mateo Superior Court, Bar Association and community, reviews panelist applications approximately once a year. Please call for the annual deadline date. The ADR Program is committed to making available to the public a core group of qualified, dispute resolution professionals who may be privately retained by parties to help in the resolution of their dispute. Although applicants may meet the minimum training and experience requirements outlined in the application, these qualifications represent a floor not a ceiling for panelists. The program must limit the number of qualified panelists who serve on the panel at any one time. Presently, we are looking for individuals who either add to the professional and/or personal diversity of our current panel or who specialize in areas in which there is a demonstrated need for additional panelists. If you are applying to the court222s Probate ADR Program, please add a narrative sheet detailing your probate-related experience. When completing the application, please be as specific as possible, especially with regard to the number of hours of training you have received and the number of mediations and/or arbitrations you have conducted. In San Mateo Superior Court cases, parties have the choice of either selecting a neutral from our panel or selecting a neutral who is not affiliated with the court222s program. The selection of the neutral rests entirely with the parties. Since parties have the option to select whomever they would like to handle their case, the Civil ADR Program acts as a starting point for parties to find qualified neutrals; it does not limit the universe of potential providers. Feel free to contact us at (650) 261-5075 or (650) 261-5076 should you have any further questions. Very truly yours, ADR Staff American LegalNet, Inc. www.FormsWorkFlow.com San Mateo Superior Court ADR Program Panelist Application for Mediation, Binding Arbitration and Neutral Evaluation Panels Application for: (check one or both) Civil ADR Program: Probate ADR Program I. GENERAL INFORMATION Name: Current Occupation: Address: Firm/Office Number: Telephone Number: Length of time employed at firm? Facsimile Number: E-mail address: Best time to call: Confidential and Optional: Home address and telephone number: Relevant Experience As applicable: Date admitted to the California Bar: ( ) Active ( ) Inactive Bar Number: Summarize legal experience (including teaching) particularly during the last five years: Number of years engaged in active litigation: Please indicate the percentage of your practice in the last five years spent representing: Plaintiff % Defense % Are you licensed in a profession or occupation other than the practice of law? Occupation: Licensing Agency: State: License Number: Summarize professional experience particularly during the last five years: DatesPositionPlace of Employment Form ADR-10 [Rev. May 2019] American LegalNet, Inc. www.FormsWorkFlow.com Form ADR-10 [Rev. May 2019Languages/Bi-Cultural Capabilities Languages: Bi-cultural capabilities: Degree of Fluency (Comfortable conducting ADR session in foreign language): II. SUBJECT MATTER AND PROCESS EXPERTISE Please indicate no more than seven subject matter areas with which you have expertise: Private BindingMediationSubject Matter Arbitration Neutral Evaluation Personal Injury Employment Business Real Estate/Eminent Domain Probate: Estates and/or Conservatorships Construction Defect Public Agency Insurance Legal Malpractice Medical/Dental Malpractice Environmental Intellectual Property Securities Class action/complex litigation Other Areas of Subject Matter Expertise (Specify) Working Style Mediators: Please characterize the primary thrust of your mediation style: Facilitative/Nondirective (does not tend to make substantive evaluations but may make process suggestions) Evaluative/Directive (takes a strong role in leading parties to a solution, more of a settlement conference style) Other/Comments If you would like to characterize your style for other ADR processes please do so. American LegalNet, Inc. www.FormsWorkFlow.com Form ADR-10 [Rev. May 2019III. TRAINING, EXPERIENCE AND PERFORMANCE REQUIREMENTS For mediation panel applicants: Please check off which combination of training and experience (Track A, B or C) you believe qualifies you for inclusion on the Civil ADR Program222s mediation panel. For other panels, check off if you believe you qualify and would like to be considered for inclusion on panel(s). MEDIATION Track A Have completed at least 5 days of continuous participatory education or training including role playing in mediation and Have participated as a mediator or co-mediator in at least 5 mediations. Track B Have completed at least 2 days of continuous, participatory education or training including role playing in mediation and Have participated as a mediator or co-mediator in at least 15 mediations. Track C Provide other satisfactory evidence of mediation skills and experience. PRIVATE ARBITRATION Admitted to the practice of law for at least ten years and Have served as a neutral in at least 5 on site private arbitrations. These requirements may be modified in individual circumstances for good cause. NEUTRAL EVALUATION Admitted to the practice of law for at least ten years and, if accepted to the panel, will commit to participating in a 3-5 hour training session offered by MAP. ADR Experience as a Neutral Indicate ADR process used (mediation, arbitration, neutral evaluation or other), organization, number of cases, case types, number of hours, dates and location. (For example: Santa Clara Superior Court, 7 personal injury mediations, each mediation approx. 5 hours, 2001-2003, Santa Clara County.) Please be as specific as possible with regard to the number of cases and general case type while being careful not to reveal confidential case information. (Add further pages if necessary) American LegalNet, Inc. www.FormsWorkFlow.com Form ADR-10 [Rev. May 2019]ADR Training Programs Completed Training: Organization/Trainer222s Name, Number of Hrs/Dates. Indicate Med., Arb. or Neutral Evaluation (For example: Steve Rosenberg, 40 Hour Mediation Training, September 52268, 2000). For arbitration panel applicants, please indicate the number of arbitrations you have conducted which were: Binding Arbitrations: Non-Binding Judicial Arbitrations: Are you currently an ADR neutral? Yes No (Check as many as apply) Private Practice Firm Organization Volunteer Agency Court Firm name: ADR organization(s): Volunteer agency name(s): Court approved ADR list (indicate which court ADR programs): Other agencies or organizations for which you are an approved neutral: Education Degree/CertificatDatesCourse of StudySchooles Membership in Professional Organizations Professional and/or Personal Diversity Please describe what elements of professional and/or personal diversity you would bring to the Civil ADR Program if selected for the panel (please use additional pages if necessary): American LegalNet, Inc. www.FormsWorkFlow.com References Please list only persons with whom you have worked as a neutral. Provide three references for each panel on which you are applying to serve. We encourage you to be mindful of the confidentiality requirements and to seek prior permission to use these names. (Add pages if necessary) Attorney: or Client: in a Mediation: Arbitration: Neutral Evaluation: Other (specify): Name: Position: Organization: Address: Telephone Number: Fax Number: Attorney: or Client: in a Mediation: Arbitration: Neutral Evaluation: Other