DC Refers Mediator Application

DC Refers Mediator Application

DC Refers Mediator Application:

In joining our directory, you agree that clients who contact you from our website should expect to pay no more than $75 per hour with a minimum mediation session fee of $150.

How to submit your application:

The application should take less than 30 minutes to complete. Please gather the required information and documents prior to beginning this application. You will need:
1. Your resume
2. Email & phone information for two professional references
3. Email & phone information for two mediation client references
4. Your client mediation services agreement/confidentiality agreement
5. A fee schedule for clients whose incomes are between 200-400% of federal poverty guidelines
6. A non-refundable application fee of $50

Our online directory is open to mediators who offer mediation services to modest-means clients. Modest-means clients are clients with annual incomes between 200%-400% of the Federal poverty levels.

- You agree to promptly let a prospective client know whether or not you have accepted them as your client.*
  
  Yes
- You agree to enter into a written fee agreement with clients.*
  
  Yes
- You understand that our DC Refers may ask your clients to evaluate your services.*
  
  Yes
- You understand that you must conduct your mediation practice in accordance with the District of Columbia Uniform Mediation Act (https://code.dccouncil.us/dc/council/laws/docs/16-87.pdf).*
  
  Yes
- You agree to contact us if you want to temporarily or permanently remove your profile from our site.*
  
  Yes
- You agree to remit to DC Refers a fee of $50 to apply to join DC Refers.*
  
  Yes
- You agree to complete periodic surveys or evaluations of DC Refers.*
  
  Yes
- You understand that not complying with any of the above terms is grounds for removal from this directory. Additionally, you understand that you can be removed from the directory for cause.*
  
  Yes
- You agree to indemnify and hold harmless the DC Refers Board of Directors and its agents from any claim, loss, damage, expense or injury to any person, or property of any person, injured through any negligence committed, omissions, or acts undertaken while performing mediation services on behalf of an individual referred to you by DC Refers.*
  
  Yes

- Full Name*
- Your Phone Number*
  
  Area CodePhone Number
- Identify which email address you would like us to send application updates to:*
- Website address
  Leave blank if not applicable
- DC Bar number
  Leave blank if not applicable

- Have you taken mediation training?*
  
  YesNo

You are not eligible to join our directory of mediators if you do not have mediation training.

Please consider re-applying when you have completed mediation training.

Please describe the mediation training you have taken. indicate the name of the trainer or organization providing the training, the dates of the training and the length of the training (i.e. number of hours).*

- Attach a copy of your client mediation services agreement/ your mediation confidentiality agreement*
  
  Upload a File
  
  Cancelof
- Attach a copy of your fee schedule for clients whose incomes are between 200-400% of federal poverty guidelines.*
  
  Upload a File
  Your hourly rate/rate schedule will be used internally only. Clients will not be able to see your hourly rate/rate schedule. Cancelof
- Attach your resume*
  
  Upload a File
  
  Cancelof

- Please provide two professional references and two client references. Examples of professional references include: fellow mediators, mediation program administrators, mediation trainers, former employers, co-workers or colleagues. Client references should be from persons for whom you performed mediation services.
- Professional Reference #1*
  
  First NameLast Name
- E-mail
- Phone Number*
  
  Area CodePhone Number
- Professional Reference #2*
  
  First NameLast Name
- E-mail
- Phone Number*
  
  Area CodePhone Number
- Client Reference #1*
  
  First NameLast Name
- E-mail
- Phone Number*
  
  Area CodePhone Number
- Client Reference #2*
  
  First NameLast Name
- E-mail
- Phone Number*
  
  Area CodePhone Number

- Application Fee*
  prevnext( X )
  Non-Refundable Application Fee$50.00
  
  Current Lawyer Mediator Application$ Free
  Please choose this option if you are a current lawyer panel member and want to join the mediator panel
- How did you hear about DC Refers?*
  
  D.C. Bar websiteAd in the Washington Lawyer MagazineDC Consortium List ServA colleagueOther
- Media Consent
- From time to time DC Refers highlights a member on its Facebook page and Twitter feed, or otherwise tries to increase awareness of our members and our service. If you would like to participate in these activities, please check the following box:
  
  I give the DC Refers permission to use my name, likeness, biography and other non-proprietary information on the web, in print, and on social media for the purpose of increasing awareness of the online directory and to otherwise further the mission of DC Refers.I do not give consent.
- Should be Empty: