Civil Dispute Resolution Program Application City 7 State n Zip Code 7 Current Employment I Occupation: Position / Title: 1 PLEASE INDICATE THE PROGRAMS IN WHICH YOU WISH TO PARTICIPATE (Please do not select a program for which you do not meet the qualifications) l-l ARBITRATION l-l MEDIATION n CASE EVALUATION Legal Background & Experience Year Admitted to D.C. Bar: 7 Bar Number: Jurisdiction: Year Admitted to Practice (if different): m Number of civil trials completed: 7Trials in D. C. Superior Court? AREAS OF SIGNIFICANT LEGAL EXPERIENCE q q Administi-ative Law Automobile iC$l zts 0 eci q Corporations/Partnerships q Criminal q Construction Contracts (general) q (check all that apply): Commercial Transactions Domestic Relations Legal Malpractice Landlord/Tenant Medical Malpractice Mental Health Personal Injury/Negligence Product Liability Probate Real Estate Securities Law Services Rendered Tax Torts (general) It is our policy to accept volunteers based on qualifications and merit only, without regard to race, color, religion, sex, age, disabilities, national origin, marital status, personal appearance, sexual orientation, family responsibilities, matriculation, political affiliation, source of income, or place of residence or business. Please provide the following information: Sex: Race: Female Male African American Caucasian Hispanic Asian 2001 © American LegalNet, Inc. C o m m u n i t y A c t i v i t i e s : (Please list major community I volunteer activities Organizations(s) only) Yearsactive Dispute Resolution Training & Experience: Please provide details (name of program, place, year) of any dispute resolution training or experience (mediation, arbitration, case evaluation) you have had, at D.C. Superior Court or elsewhere: Program(s) Year(s)) Experience: From To By my signature below, I acknowledge that if I am accepted into a Multi-Door training program, I will be required to make a firm commitment to the Superior Court of the District of Columbia. During the year immediately following successful completion of training, I agree to accept the assignment of no fewer than twenty (20) civil division cases for which I will serve as mediator or neutral case evaluator; or to accept the assignment of no fewer than eighteen (18) civil division cases for which I will serve as arbitrator Signature Date [Invitation to a particular screening session or training class can not be guaranteed. Please refer to the enclosed information.] Please r t r this form to: eu n WaIlace Meissner Civil Training Manager Multi-Door Dispute Resolution Division D.C. Superior Court 500 Indiana Avenue, N.W. Washington D.C. 20001 Phone: 202-879-1974 2001 © American LegalNet, Inc.