United States District Court Northern District of Alabama Application for Court Annexed ADR Panel of Neutrals I hereby apply to serve on the Federal Court Panel of Neutrals to be established and maintained by the court in conjunction with the court's Alternative Dispute Resolution Plan adopted on December 1, 1993. I understand that, if accepted by the court, I acquire no rights by being placed on the panel and that I may be removed for any cause at the sole discretion of the Chief Judge, or his designee. I also understand that if this application is accepted I will be encouraged, but not required, to serve as a neutral in appropriate ADR proceedings, without remuneration, at least five hours annually. I certify that the answers given in this application are full, true and correct to the best of my information, knowledge and belief. Date Signature Social Security/State Bar/ID Number ADR Neutral Panel Questionnaire Instructions: Please provide the information requested, using additional sheets as necessary. The court's Alternative Dispute Resolution Plan is available as a part of the court's Civil Justice Reform Act Plan and can be obtained from the Clerk of the Court. When you have completed the application, sign it and return to: The Clerk of Court United States District Court Northern District of Alabama 1729 Fifth Avenue North Birmingham, Alabama 35203 Attn: Coordinator, ADR Neutral Panel The court will notify you if you have been added to the panel. American LegalNet, Inc. www.USCourtForms.com 1. Name: Give your full name (to include Jr., Sr., III, and include any other names you have used or by which you have been known). 2. Address: Please give your business mailing address; name of law firm, company, or agency; and include your telephone number as well as your fax number. 3. Education: List each college and law school you have attended, including dates of attendance, degrees received and dates. 4. Honors and Awards: List scholarships, fellowships, honorary degrees and honorary society memberships that you have received. 5. Bar Associations: List all bar association, legal or judicial-related committees or conferences of which you are or have been a member and give the titles and dates of any office which you have held in such groups. −2− American LegalNet, Inc. www.USCourtForms.com 6. Court Admissions: List all courts in which you have been admitted to practice, with dates of admissions and lapses, if any. Please explain the reason for any lapse of membership. Give the same information for administrative bodies which require admission to practice. 7. Published Writings: List the titles, publishers, and dates of books, articles, reports, or other published material you have written or edited. 8. Judicial and Other Public Offices: List chronologically any judicial or other public office you have held. If you have held judicial office, please describe the jurisdiction of the courts over which you presided. 9. Legal Career: a. Describe chronologically your law practice and experience after graduation from law school including: i. whether you served as a clerk to any judge, and if so, the name of the judge, the court, and the dates of your service; −3− American LegalNet, Inc. www.USCourtForms.com −4− American LegalNet, Inc. www.USCourtForms.com ii. whether you practiced alone, and if so, the addresses and dates; iii. the dates, names and addresses of law firms or offices, companies or government agencies with which you have been connected, and the nature of your connection with each. b. c. 10. What has been the general character of your law practice, dividing it into periods with dates if its character has changed over the years? Please describe any areas of law in which you have specialized. Please describe the five most significant legal matters in which you have engaged as an attorney during the past ten years. Professional Conduct: Has any court, administrative agency, bar disciplinary committee, or other governing body ever sustained a complaint of misconduct, however it might have been termed, against you personally or have you ever been found vicariously liable for the misconduct of any other member of the bar? Please explain. −5− American LegalNet, Inc. www.USCourtForms.com 11. General Information: Please include any additional information which you believe will aid the court in evaluating your application. 12. Training: Are you willing to engage in educational activities, as prescribed by the court, in order to develop the requisite knowledge and skills to become an effective ADR Neutral? 13. Pro Bono Service: Are you willing to serve without remuneration in a limited number of cases? If so, please indicate the number of hours you are willing to so serve annually. −6− American LegalNet, Inc. www.USCourtForms.com