Application for Family Division Private Mediation & Collaborative Practice Panels

Mediators who wish to be added to the Family ADR database are encouraged to submit this online application.

1. Check each panel for which you are applying:

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Education/Degree Description
Date Received

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ADR Training Description
Trainer's Name
Date Attended
Total Hours

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Describe the Subject Matter of Dispute
Date
Sole- or Co-Provider

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Organization Name
Service Provided
Date Provided
7. Check your areas of substantive expertise:

8. What is your State Bar No.?

14. Please attach a recent resume or CV to an email and send it to FamilyADR@scscourt.org .

Instead of entering a name, you may attach a letter of recommendation to an email and send it to FamilyADR@scscourt.org .

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Name
Phone

Please read and sign the following agreement:

1. I agree to be bound by the ADR rules of the Santa Clara County Superior Court.

2. I agree to waive any and all claims against the Santa Clara Superior County Court in connection with my ADR services for a court-referred dispute.

3. I agree to submit any fee dispute arising out of my ADR services for a court-referred dispute to arbitration, either under Business and Professions Code section 6200 et seq. or by stipulation or court order.

4. I agree to adhere to the ethical standards for alternative dispute resolution providers as adopted by the court.

5. I agree to accept at least one pro bono case (maximum 10 hours per case) or modest means case a year.

6. I am in good standing with the State Bar of California.

7. I agree to indemnify, defend and hold harmless the Santa Clara County Superior Court, its judges, and employees from any claim, lawsuit, damages or liability of any kind, arising out of any conduct of mine in the rendering of services to any person or persons in connection with my inclusion on the ADR providers' list maintained by the Superior Court.

8. I agree to have my background information posted on the Court's ADR website.
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Date
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