ATTORNEY-CLIENT MEDIATION AND ARBITRATION SERVICES VOLUNTEER

ATTORNEY-CLIENT MEDIATION AND ARBITRATION SERVICES VOLUNTEER

Volunteer Application
I want to be a:
I am a:
[ ] Mr. [ ] Mrs. [ ] Ms. [ ] Dr. [ ] Other Title
Name
Firm
Address
Address
Telephone Number: Work
Format: (000) 000-0000.
Telephone Number: Home
Format: (000) 000-0000.
Fax
E-Mail
IF AN ATTORNEY:
Date admitted to California Bar

MonthDayYear
Date
Years of active litigation experience:
Status:
If you are admitted to practice in California, what is your State Bar number?
If you are an attorney, have you ever been subject to any disciplinary action by the State Bar of California?
If you are an attorney, have you ever been subject to any disciplinary action by the State Bar of California?
If you answered “yes” to the above, please explain.
Professional Background
What is your profession if you are not an attorney?
List professional associations of which you are a member, and offices held if applicable.
Areas of Practice

Practice Areas

Rows	Years of Experience
Civil
Criminal
Plaintiff
Defense
Both Plaintiff and Defense
Business Litigation
Other

Please check primary areas of expertise:
Other:
Training
The State Bar’s Minimum Standards requires mediators to complete a minimum of 40 hour mediator skills training. Please give the name, year, location of the course(s), number of hours of training, the approximate date of completion, and any advanced level mediator skills courses taken. Please attach documentation that certifies completion of mediation training in accordance to the California Dispute Resolution Programs Act.
Have you ever served as a mediator trainer or as a role-play coach in a mediator training program? If yes, please specify.
Describe any other dispute resolution training you have completed that you feel may be relevant to your application. You may attach, if you wish, an additional one-page sheet in response to this question.
Education

List two highest degrees received. List in reverse order, with most recently attended institution first:

Rows	School Name	Location	Degree Awarded	Year Awarded
Most recent
Second recent

ALL APPLICANTS:
Please check locations that you would be willing to serve:
Have you acted previously as an arbitrator? If so, describe, including whether you have served as a sole arbitrator or chair of a Multi-arbitrator panel:
Please list any organizational arbitrator rosters or panels to which you are currently certified as a member.
How many cases have you served on as an arbitrator of disputes involving matters other than fee arbitration?
Have you received other arbitrator or mediator training? If so, please describe:
Fee Arbitration Experience
Are you a LACBA/ACMAS Attorney-Client Fee Arbitrator?
Are you a Fee Arbitrator with another local bar association?
If you answered “no” to both of the above two questions, have you completed an attorney-client fee arbitrator-training course in the State of California? If “yes,” please give the name and location of the course, the sponsoring training organization, and the approximate date you completed the course. If you answered “yes” to either of the above, on how many fee arbitration cases have you served as an arbitrator to completion, that is, served on where an arbitration award was rendered?
Have you ever been a party to an attorney-client fee arbitration case, whether as petitioner or respondent?
If you answered “yes” to the above, please explain. You may attach, if you wish, an additional one-page sheet in response to this question.
Please list the legal or business areas in which you practice or have expertise. List them in order of your primary area of practice/expertise, with the first listing being your heaviest practice area:
Mediation/Arbitration Experience and Credentials
How many cases have you served on as a mediator?
How many cases have you served on as the sole or lead mediator?
How many cases have your served on as mediator that involved a business, commercial, consumer, employment, insurance, or fee dispute matters?

Rows	%
What is your best estimated settlement rate for the mediation cases on which you served as mediator?
Private business, commercial, consumer, employment, insurance or fee dispute mediations
Community, neighbor, landlord-tenant, and other related pro bono mediation cases

Describe your primary mediator style/approach:
If another, please explain:
Please list any organizational mediator rosters or panels to which you are currently certified as a member.
How many cases have you served on as an arbitrator of disputes involving matters other than fee arbitration?
How many cases have you served on as an arbitrator that involved a business, commercial, consumer, employment, insurance, or fee dispute matter?
The following additional information would be helpful:
Select your memberships, if any:
Other bar associations or dispute resolution organizations (specify)
Please provide any additional information on your arbitrator or mediator experience that would be helpful for us to know:
Recommendations, if any:
I have been requested by the following judge or one of the organizations noted above to submit this application:
I recommend the following person to act as a mediator/arbitrator:
If you are bilingual, what languages do you speak?
Please attach your files here:

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APPLICANTS MUST SIGN THE FOLLOWING AFFIRMATION:
I affirm that I have read and understand the preceding questions and that my answers are true and complete to the best of my knowledge. If approved to the roster, I agree to abide by the Los Angeles County Bar Association’s (LACBA) Fee Arbitration and Mediation Rules and to inform LACBA of any changes to the answers to the questions contained on this form. I understand that this is a voluntary position and that there is no compensation except as proscribed under LACBA rules.

I swear under oath, and subject to the penalty of perjury, that the foregoing information is true and correct to the best of my knowledge.
Signature
Print or type Full Name
Dated
Thank you for your cooperation with submitting an application to volunteer for Los Angeles County Bar Association. Please call this office if you have any questions about the application form or the LACBA qualification requirements.

Attorney-Client Mediation & Arbitration Services Post Office Box 55020 Los Angeles, CA 90055 Phone: 213/896-6426 Fax: 213/833-6718
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ATTORNEY-CLIENT MEDIATION AND ARBITRATION SERVICES VOLUNTEER

IF AN ATTORNEY:

Professional Background

Training

Education

ALL APPLICANTS:

Fee Arbitration Experience

Mediation/Arbitration Experience and Credentials

Recommendations, if any:

APPLICANTS MUST SIGN THE FOLLOWING AFFIRMATION: