UPDATED 7/10/02IDAHO SUPREME COURT APPLICATION FOR REGISTRATION AS APRIVATE CIVIL LITIGATION EVALUATOR(Section 7-1501, et seq., Idaho Code, and Rule , I...) GENERAL INFORMATION1.Registration: Qualifications of Private Civil Litigation EvaluatorsTo be placed on the Supreme Court's list of private civil litigation evaluators, the applicant must be amember of the Idaho State Bar in good standing who has been a member of the Idaho State Bar for aperiod of not less than seven (7) years, or be a retired or senior justice or judge. In addition, the applicantmust be familiar with the Small Lawsuit Resolution Act (Section 7-1501, et seq., Idaho Code) and therules of the Idaho Supreme Court governing the resolution of civil disputes in the district courts of theState of Idaho.2.Supporting DocumentationAn applicant must submit the following to be placed on the list of evaluators maintained by the SupremeCourt:A.The attached application; andB.An affidavit of compliance executed by the applicant attesting that the applicant hasfulfilled the requirements for registration.3.Applications should be mailed to:Administrative Director of the CourtsIdaho Supreme CourtP.O. Box 83720Boise, ID 83720-0101Telephone: (208) 334-2246 American LegalNet, Inc. www.FormsWorkFlow.com UPDATED 7/10/02IDAHO SUPREME COURT451 WEST STATE STREETP.O. BOX 83720BOISE, IDAHO 83720-0101(208) 334-2246 APPLICATION FOR REGISTRATION AS A PRIVATE CIVIL LITIGATION EVALUATOR (Section 7-1501, et seq., Idaho Code, and Rule , I....) NAME Organization Mailing Address Suite City County State ZIP Telephone ( ) Extension FAX ( ) E-Mail Address The information you furnish above will be used in all correspondence with you and in the Supreme Court222slist of private civil litigation evaluators. I herewith apply for registration on the list of private civil litigation evaluators maintained by the IdahoSupreme Court pursuant to Rule , I.... In support of this application, I state the following:I am an active member of the Idaho State Bar in good standing and have been a member of this Bar for aperiod of seven (7) or more years.I am a retired justice or judge of the Idaho Judiciary or have been designated a senior judge for the Stateof Idaho pursuant to Section 1-2005 or 1-2221, Idaho Code.I submit the following information for inclusion on the Supreme Court's roster of private civil litigationevaluators. (Please print or type this information in the space provided below using the attached legendof abbreviations where appropriate.) (Attach a separate sheet of paper as an addendum to this applicationif additional space is needed.) American LegalNet, Inc. www.FormsWorkFlow.com UPDATED 7/10/02(1)I have engaged in the practice of law in the State of Idaho for years. I have also practicedlaw in the following jurisdictions during the time period(s) indicated: (2)Professional Affiliations: (bar organizations, alternative dispute resolution organizations, etc.) (3)Academic and Professional Education and Training: (4)Professional Experience:(a)Describe your areas of practice or specialty: (b)Describe your litigation experience: (c)Describe your alternative dispute resolution experience: (d)Describe any other professional experience you have that is pertinent to your abilityto conduct an evaluation of a civil dispute: (5) My hourly rate of compensation, if any, to evaluate a civil case pursuant to Section 7-1501, et seq., Idaho Code, and Rule , I.... is $. (Note: Section 7-1505, Idaho Code, provides that the fee of an evaluator cannot exceedone thousand dollars ($1,000), unless the parties to the evaluation agree otherwise. (6)I will charge the following rate of compensation while traveling to and from an evaluation: American LegalNet, Inc. www.FormsWorkFlow.com UPDATED 7/10/02(7)I require reimbursement of the following expenses incurred in connection with an evaluation: (8)I will 001 will not 001 agree to accept appointments as a private civil litigation evaluator on apro bono basis pursuant to Section 7-1505(1), Idaho Code. If you are willing to accept probono appointments, specify the conditions, if any, for your acceptance: (9)In addition to the county of my mailing address, I am willing to conduct evaluations of civilcase litigation in the following counties: (10)In each case, I am prepared to sign an oath to faithfully and impartially discharge the duties ofan evaluator in a timely manner, as prescribed by law, and that I will identify any conflict ofinterest that I have regarding the parties or the subject matter of the dispute.(11)I will promptly notify the Administrative Director of the Courts regarding any changeconcerning my status and standing with the Idaho State Bar or other information I haveprovided in this application.Signature Date Please return the completed Application and Affidavit of Compliance to:Administrative Director of the CourtsIdaho Supreme Court451 West State StreetP.O. Box 83720Boise, ID 83720-0101 American LegalNet, Inc. www.FormsWorkFlow.com UPDATED 7/10/02IDAHO SUPREME COURTAPPLICATION FOR REGISTRATION AS APRIVATE CIVIL LITIGATION EVALUATORAFFIDAVIT OF COMPLIANCEState of )) ss.County of )To the Idaho Supreme Court:I, , being first duly sworn, deposeand say that: I am the applicant who has signed the attached application for the placement of my name onthe roster of private civil litigation evaluators maintained by the Idaho Supreme Court in accordancewith Section 7-1504, Idaho Code, and the Idaho. By signing the applicationand this affidavit, I certify that I have fulfilled the requirements for being listed as a private civillitigation evaluator on this roster. I fully realize that the determination as to whether I am placed on the Idaho Supreme Court'slist of private civil litigation evaluators depends on the truth and completeness of my answers setforth in the application and any addendums that are attached. To my knowledge, the answers,statements, and information which I have supplied in connection with the application are true andcomplete. I have read and understand the contents of Section 7-1501, et seq., Idaho Code (SmallLawsuit Resolution Act), and Rule of the Idaho C relating to civil caseevaluations, and I will conduct the evaluation of any civil cases to which I am appointed inconformance therewith. DateApplicant's SignatureSubscribed and sworn to before me this day of ,20. (SEAL)SignatureResiding at My Commission Expires American LegalNet, Inc. www.FormsWorkFlow.com UPDATED 7/10/02LEGEND OF ABBREVIATIONSAAA =American Arbitration AssociationABA =American Bar AssociationABTA =American Board of Trial AdvocatesACR =Association for Conflict Resolution (a merged organization of Academy of Family Mediators-AFM,Conflict Resolution Education Network 226CREnet, and Society for Professionals in DisputeResolution -SPIDR)ACTL =American College of Trial LawyersCA =Courthouse Alternatives, Inc.CPM =Certified Professional Mediator by the Idaho Mediation AssociationCRCI =Conflict Resolution Center, Inc.IADC =Idaho Association of Defense CounselILF =Idaho Law FoundationIMA =Idaho Mediation AssociationInns =Inns of CourtISB =Idaho State BarISC =Idaho Supreme CourtITLA =Idaho Trial Lawyers AssociationU.S.C.A. =United States Court of AppealsU.S.D.C. =United States District CourtU.S.S.Ct. =United States Supreme Court American LegalNet, Inc. www.FormsWorkFlow.com