SKAGIT COUNTY SUPERIOR COURT GUARDIAN AD LITEM APPLICATION TITLE 11.88 ______ TITLE 26 ______ (Please check which Title applying for) CONTACT INFORMATION LAST NAME FIRST NAME MIDDLE DATE BUSINESS NAME OR FIRM STREET AND MAILING ADDRESS CITY STATE ZIP BUSINESS PHONE RETAINER AMOUNT HOURLY RATE COMMENTS COMMENTS EDUCATION LEVEL AND LOCATION OF FORMAL EDUCATION (ATTACH DETAILED RESUME - MANDATORY) CERTIFIED GUARDIAN AD LITEM TRAINING DATE AND TYPE OF INITIAL TRAINING DATE AND TYPE OF ANNUAL REFRESHER TRAINING (ATTACH COPY) OTHER FORMAL TRAINING/CERTIFICATIONS/LICENSES (INCLUDE DATE AND TYPE) RELEVANT EXPERIENCE PUBLIC PAY APPOINTMENTS THIS YEAR (LIST NAME & CASE NUMBER) LIST OTHER EQUIVALENT EXPERIENCE NUMBER OF YEARS AS A GUARDIAN AD LITEM LIST ALL COUNTIES OF APPOINTMENTS NUMBER OF APPOINTMENTS AS A GUARDIAN AD LITEM LIST ANY AND ALL CIRCUMSTANCES OF REMOVAL FROM ANY G.A.L. REGISTRY PURSUANT TO A GRIEVANCE ACTION. PROVIDE NAME OF COURT AND THE CASE NUMBER FROM WHICH YOU WERE REMOVED. CERTIFICATION I certify under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. Signed this ____ day of ________________, at __________________, Washington. (Signature of Applicant) __________________________________________________ I:\Superiorcourt\Documents\Galapp.Doc American LegalNet, Inc. www.FormsWorkFlow.com