UNITED STATES DISTRICT AND BANKRUPTCY COURT FOR THE DISTRICT OF IDAHO
550 West Fort Street Boise, Idaho 83724
MEDIATOR APPLICATION
TO: Denise Asper, ADR Program Coordinator U.S. District Court, District of Idaho MSC 039, 550 West Fort Street Boise, ID 83724 (208) 334-9067 Fax: (208) 334-9215
APPLICANT:_________________________________________________________
Address:_____________________________________________________ _____________________________________________________________
Telephone:________________________Fax:_______________________ E-Mail:______________________________________________________
(1)
Date of admission to practice law and years practiced:
(2)
Professional Affiliations and Membership: (i.e., Bar membership(s), ADR associations, etc.)
(3)
Mediation Training:
Hours of Training: Name of institution(s), college(s), or Date: trainer(s), content of course(s): _____________________________________________________________________
(4)
Fees: (Do you include expenses?)
I am applying to be on the Mediator Roster. I have never been disciplined in any fashion at any time for any action or inaction related to the practice of law or the providing of ADR services and I certify that the above is true and correct. I authorize the federal court to verify any of the above information. Date: ___________________________________________ Applicant Signature