SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN FRANCISCO APPLICATION FOR ORGANIZATION OR FIRM LISTING Organization/Firm Name: Contact Person: Address: Telephone: ( ) Fax: ( ) Email: 1. Please provide a brief description of your organization, its relevant characteristics, the services it provides and how long it has been providing ADR services. 2. If you provide training to your mediators, please complete the following information: a) Briefly describe the nature and scope of the training b) The length of the training 3. If your organization does not provide training, what training do you require of your mediators? 4. What other experience and qualifications do you require of your mediators? American LegalNet, Inc. www.USCourtForms.com 5. a) Check areas of expertise or background in mediations provided: ( ) Maritime ( ) Intellectual Property ( ) Real Property ( ) Tax ( ) Labor/Employment ( ) Business ( ) Construction/Real ( ) Landlord/Tenant Estate ( ) Environmental ( ) Family Law( ) Personal Injury custody/visitation ( ) Other (please indicate) ( ) Other Quality of Life Issues (e.g., neighbor disputes ''barking dog'') ( ) Partnership/Corporate Governance ( ) Land Use ( ) Professional Negligence ( ) Probate ( ) Family Law/Other b) Indicate any other special attributes, skills, interests or aspects of your practice: 6. Describe the fee structure for mediations. If there is a sliding scale fee or other arrangement available for lower income parties, please describe: 7. Please state and explain any administrative fees charged by your organization in setting up a mediation. If a sliding scale fee or other arrangement is available for lower income parties, please describe: 8. Will your organization accept cases where a party is not represented by counsel? ( ) YES ( ) NO 9. If your organization is able to conduct mediations in languages other than English, please indicate which languages: American LegalNet, Inc. www.USCourtForms.com 10. Please indicate how the parties select a mediator from the organization's list of providers: Parties choose mediator(s) from a list; Organization selects mediator(s) from a list; Either option is available 11. a) Other information about your organization which should be considered in reviewing your application. b) Other information which could be included in a description of your organization's mediation practice. 12. In completing this application, the organization represents: o The mediators on the attached list have the training and qualifications required of individual mediators under Local Rule 18.9(c)(2). o Its mediators are willing and able to conduct mediations in San Francisco, if that is where the parties prefer to meet. o Its mediators have read the STANDARDS OF CONDUCT FOR MEDIATORS and agree to abide by them. o Its mediators agree to complete all mediation program forms as directed by the Court. o Its mediators agree to mediate one pro bono case per year assigned by the Court. I certify, under penalty of perjury, that the information on this application is true and correct. Signature: Print name: Title: Date: Return this form, a current list of the organization's mediation providers and additional written information as described in the application instructions to: ADR Program Coordinator San Francisco Superior Courts 400 McAllister, Room 103 San Francisco, CA 94102-4514 Phone: (415) 551-3876 FAX: (415) 551-5748 2004 City & County of San Francisco American LegalNet, Inc. www.USCourtForms.com