Probate Mediator Application

OAKLAND COUNTY CIRCUIT COURT PROBATE MEDIATOR APPLICATION For further information, including information about minimum qualifications promulgated by the State Court Administrative Office, please refer to the Interim Mediation Training Standards and Procedures, the SCAO Administrative Memorandum 2001-01 and MCR 2.411. Service as a case evaluator under MCR 2.403 does not constitute a qualification for serving as a mediator. Please type or print neatly. 1. 3. 5. 7. 9. Full name (first, middle initial, last) Address where you can be contacted Other address (if different from above address) Current employer's name Previous employer's name 12. Date admitted to State Bar (if applicable) 2. Bar no. (if applicable) Telephone no. E-mail address Number of years with employer P 4. 6. 8. 10. Number of years with employer 13. Years in practice (if applicable) 11. Fax no. Part A: General Information 14. 15. Is this a new application? renewal? Yes No Are you currently a member in good standing of the State Bar of Michigan? (attorneys only) Part B: Probate Mediator Qualifications (Complete either item 16, item 17, or item 18 as appropriate) Where indicated you must provide the written evidence requested. If you are applying based on training completed before February 10, 2001, please see either sections 17 or 18, whichever is appropriate. 16. Qualification through State Court Administrative Office (SCAO) Approved Training To be eligible to serve as a probate mediator, you must meet the following minimum qualifications: · · · a. You must have completed a training program approved by the State Court Administrator. You must have one or more of the following: a) a juris doctor degree; b) graduate degree in conflict resolution; or c) 40 hours of mediation experience over two years, including mediation, co-mediation, observation, and role-playing in the context of mediation. You must have observed two general civil or probate mediation proceedings conducted by an approved mediator, and have conducted one general civil or probate mediation to conclusion under the supervision and observation of an approved mediator. SCAO Approved training completed on _______________________________. Please attach a certificate of completed training. Date Trainer: _________________________________________________________________________________________________ b. Attorney or Graduate degree in conflict resolution or 40 hours of mediation or co-mediation experience in the two years prior to this application. Detail below. Co-mediation can be documented as either experience or observation ­ do not count the same case twice. Complete on separate page if needed. Case Type Date Length of Time _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ CE 1 (0801) MCR 2.411(E) 1 American LegalNet, Inc. www.USCourtForms.com Part B: Probate Mediator Qualifications (continued) 16. c. Observed or co-mediated two general civil or probate mediation proceedings. Specify dates and name of qualified *mediator who observed or co-mediated. Co-mediation can be documented as either experience or observation ­ do not count the same case twice. Date Name of Qualified Mediator ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ d. Conducted under supervision or co-mediated one general civil or probate mediation to conclusion. Specify date and name of qualified * mediator who observed or co-mediated. Co-mediation can be documented as either experience or observation ­ do not count the same case twice. Date Name of Qualified Mediator ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ e. As a non-attorney, completed on __________________________________ a 6-hour program addressing basic laws, rules, and Date guidelines governing civil court proceedings. Trainer: ___________________________________________________________ 17. Qualification by Comparable Training and Experience; Community Dispute Resolution Program (CDRP) Note: To qualify under this section, CDRP training must have been completed prior to February 10, 2001 and an application must be submitted by December 31, 2002. a. Michigan CDRP training completed on ________________________________. Please attach a certificate of completed training. Date Trainer: _______________________________________________________________________________________________ b. Mediated or co-mediated at least 40 hours or 18 cases in the two years prior to this application. Detail below. Co-mediation can be documented as either experience or observation ­ do not count the same case twice. Complete on separate page if needed. Case Type Date Length of Time _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ c. As a non-attorney, completed on __________________________________ a 6-hour program addressing basic laws, rules, and Date guidelines governing civil court proceedings. Trainer: ___________________________________________________________ 18. Qualification by Comparable Training and Experience; Other Training and Experience Note: To qualify under this section, you must have completed at least a 24-hour training by February 10, 2001 or a 16-hour training and an 8-hour supplemental course with the same trainer approved by the SCAO by September 28, 2001. The application must be submitted by December 31, 2002. a. Completed a comprehensive training course of at least 24 hours designed for general civil case mediati