Motion For Admission Pro Hac Vice

CERTIFICATE OF COMPLIANCE The Court's Alternative Dispute Resolution Policies and Procedures (Section 2.5(B)(1)(ii)) requires that mediators complete 40 hours of mediation training, including training in the facilitative method of mediation. Upon completion of the requisite 40 hours of training, please return this form to the ADR Coordinator at: ADR Coordinator 700 Grant Street Suite 3110 Pittsburgh, PA 15219 or email to: PAWD_ADRCoordinator@pawd.uscourts.gov Please set forth all information regarding your formal training in alternative dispute resolution including a description(s) of the course(s) taken, number of hours, where and when it was given, and by what sponsoring organization. (If more space is needed, send additional pages as attachments.) I HEREBY CERTIFY THAT THE ABOVE INFORMATION IS TRUE AND CORRECT. Name of Neutral (please print): Signature: Date: American LegalNet, Inc. www.FormsWorkFlow.com