County Referral List Information Sheet
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County Referral List Information Sheet Form. This is a Vermont form and can be use in Superior Court Statewide.
Tags: County Referral List Information Sheet, 292, Vermont Statewide, Superior Court
Form 292 COUNTY REFERRAL LIST INFORMATION SHEET COUNTY: Name: Address: Phone: FAX: E-Mail: Alternative Dispute Resolution Service(s) Provided: (Check Applicable
boxes) Mediation Arbitration Early Neutral Evaluation Other (please describe) Education/Training/Certification: Experience (please describe): Hours Available: Fees Charged: I hereby agree to accept at least two referrals per year in actions in t
his county in which the clerkhas found that a party is entitled to proceed in forma pauperis pursuant
to Rule 3.I hereby agree to submit on an annual basis the information specified on
this form. Name (printed) Signature DateIn order to be placed on a county referral list, please return to the Su
perior Court Clerk in that County. 9/03 SML
