Family Law Mediator Application

SKAGIT COUNTY SUPERIOR COURT FAMILY LAW MEDIATOR APPLICATION CONTACT INFORMATION LAST NAME FIRST NAME MIDDLE DATE BUSINESS NAME OR FIRM SSN OR TAX ID (CONFIDENTIAL) STREET AND MAILING ADDRESS BUSINESS PHONE CITY STATE ZIP EDUCATION LEVEL AND LOCATION OF FORMAL EDUCATION (ATTACH DETAILED RESUME - MANDATORY) FAMILY LAW MEDIATOR TRAINING DATE, SPONSOR AND HOURS ACCOMPLISHED OF BASIC MEDIATION TRAINING (MINIMUM OF 32 HRS REQUIRED) DATE, SPONSOR AND HOURS COMPLETED OF COURT APPROVED DIVORCE MEDIATION TRAINING (MINIMUM OF 24 HRS RQUIRED) PRACTICUM: Observation of at least six two-hour family law mediation sessions divided among at least three different mediators. (You must engage in a discussion of the mediations at the conclusion of each session.) DATES: MEDIATORS: Co-mediate three family law cases from beginning to end, each with a different court-approved mediator. CASE NAMES: MEDIATORS: If approved by co-mediators, mediate a family law case solo, with a court-approved mediator observing throughout the case. CASE NAME: MEDIATOR: FAMILY LAW MEDIATOR APPLICATION American LegalNet, Inc. www.USCourtForms.com CERTIFICATION I certify under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. Signed this ____ day of ________________, at __________________, Washington. (Signature of Applicant) ________________________________ American LegalNet, Inc. www.USCourtForms.com