Mediator Panel Application Form - Superior Court Of California - County Of Fresno

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SUPERIOR COURT OF CALIFORNIA ~ COUNTY OF FRESNO
ALTERNATIVE DISPUTE RESOLUTION DEPARTMENT
MEDIATOR PANEL APPLICATION
Name___________________________________________________________
Address_________________________________________________________
City_____________________________________________________________
State________________________________________ Zip_________________
Phone_________________________ Fax______________________________
E-mail___________________________________________________________
Cell Phone Number
_____________________________
(optional and for internal use only)
Occupation____________________________ How Long__________________
Employer_________________________________________________________
Address__________________________________________________________
City_____________________________________________________________
State_________________________________________Zip_________________
Phone__________________________ Fax______________________________
E-mail___________________________________________________________
College Attended_______________________________ Degree_____________
Graduate or Law School Attended_____________________________________
Degree or Bar #________________________________Date Awarded________
Mediation Training: Include institutions, programs and dates.
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
Mediation Experience: Include number of mediations conducted in past 3 years.
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________

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