United States Bankruptcy Court Northern District of California Bankruptcy Dispute Resolution Program Resolution Advocate Application Applicant's Name: Firm: Address: City/State/Zip: Telephone: E:MAIL:______________________ AREAS OF EXPERTISE OR BACKGROUND: Accounting Banking Bankruptcy Business Commercial Construction Environment Family Labor/Employment Landlord/Tenant Lender Liability Malpractice Mediation Partnerships Personal Injury Real Estate Workouts Other (Please specify) FAX: ALTERNATIVE DISPUTE RESOLUTION BACKGROUND: Training: (Provider and Number of Hours) Other Relevant Skills/ Participation in other programs or panels: GEOGRAPHIC AREAS IN WHICH IN WHICH YOU ARE WILLING TO CONDUCT RESOLUTION CONFERENCES: Eureka San Jose Oakland Santa Rosa Salinas/Monterey Other (Please specify) San Francisco American LegalNet, Inc. www.FormsWorkFlow.com ATTORNEY APPLICANTS: I am member in good standing of the California bar or other states as itemized, and the Northern District of California. Bar # Date Admitted State of Admission______________ Date Admitted to Northern District NON-ATTORNEY APPLICANTS: I am a member in good standing of or have valid and current license with the following: Date Admitted Date Admitted ALL APPLICANTS: I hereby certify I am willing to serve as a Resolution Advocate for a term of one year and all the information in this application is true and correct. I consent to the disclosure of the information contained in this application to court personnel and to parties and their representatives whose matters have or may be referred to the BDRP. If I am applying as a bankruptcy attorney, I hereby certify that I have served as the principal attorney of record in active matters in at least three (3) bankruptcy cases from case commencement to the earlier of the date of this application or conclusion of the case or have served as the principal attorney of record for a party in interest in at least three (3) adversary proceedings or contested matters from commencement through conclusion. DATED: Signature Rev. November 7, 2016 or Email to: ron_mastroianni@canb.uscourts.gov American LegalNet, Inc. www.FormsWorkFlow.com