SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN FRANCISCO FAMILY LAW MEDIATOR APPLICATION If you would like to be listed as a family law mediator, please complete this supplemental application. Please type the application. If you have already been approved as a mediator on the Civil Mediation Panel, it is not necessary to reapply, just complete this supplemental application. If you are a new applicant, you must also complete the Mediation Provider Application. Family law mediator applications will be reviewed on a quarterly basis by the Superior Court Mediation Advisory Committee. The Committee's recommendations will be submitted to the Superior Court for approval. Organizational providers who wish to have individual members identified as family law mediators must complete one application for each individual. The minimum criteria for listing as a family law mediator are: One third of the applicant's practice must be family law or family law mediation. Applicants who are not attorneys must possess and document suitable training or education in substantive family law. Mediation training suitable for family law mediation is preferred. Applicant's Name: ______________________________________________________ Firm Name: ______________________________________________________ Address: ______________________________________________________ City, State, ZIP: ______________________________________________________ Telephone: (____)__________________ Fax: (____)____________________ Email: ______________________________________________________ California State Bar or other professional license number and type:___________________ Date admitted or date license granted:_________________________________________ Describe your practice. Estimate percent devoted to family law practice, family law mediation and other practice areas. Indicate the total number of mediations conducted in the past year. Indicate the total number of family law mediations conducted in the past year. Indicate the total number of hours devoted to conducting family law mediations in the past year. American LegalNet, Inc. www.FormsWorkflow.com If you are an attorney, are you a certified family law specialist? ( ) Yes ( ) No If you are an attorney, list the MCLE family law courses you have taken and the number of hours of each course. If you are not an attorney, describe your training and education in substantive family law. Include the name of the course(s), date(s) taken and the provider(s). Describe the family law mediation training you have taken. Include dates, number of hours and providers. Indicate the type(s) of family law mediation you provide: ( ) Custody only ( ) All aspects of family law ( ) All aspects of family law except custody Describe your fee structure. If you are able to conduct a mediation in any language(s) other than English, please list them here. 2006 City & County of San Francisco American LegalNet, Inc. www.FormsWorkflow.com