Form 522a- Referee / Arbitrator Application Form
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2STATE OF NEVADA
DEPARTMENT OF BUSINESS AND INDUSTRY - REAL ESTATE DIVISION
OFFICE OF THE OMBUDSMAN FOR COMMON-INTEREST COMMUNITIES AND CONDOMINIUM HOTELS
2501 East Sahara Avenue, Suite 202 * Las Vegas, NV 89104-4137
(702) 486-4480 * Toll free: (877) 829-9907 * Fax: (702) 486-4520
E-mail:
CICOmbudsman@red.state.nv.us
ALTERNATIVE DISPUTE RESOLUTION
REFEREE / ARBITRATOR APPLICATION FORM
(Please Print or Type)
Name: ____________________________________________________________________________________
Address: __________________________________________________________________________________
City: ____________________________________ State: _________________ Zip: ______________________
Email address: _____________________________________________________________________________
Daytime number: ______________________ Fax: ______________________ Cell: ______________________
NEVADA BAR ID# _____________________ Current Member Status: _____________________________
Must be in good standing
Current Specialization(s): ____________________________________________________________________
List major area of specialization or subject expertise related to homeowner association knowledge/operation:
real estate, CC&R’s, bylaws, budgets, accounting, injuries, construction, insurance, etc., as well as NRS 116:
__________________________________________________________________________________________
__________________________________________________________________________________________
Qualifications:
List formal training on the hearing of cases/claims and issuance of decisions:
Course/Training Titles: ______________________________________________________________________
Date(s): __________________________________ Number of Hours: _________________________________
Provider Name/Address: _____________________________________________________________________
Completion Validation: ______________________________________________________________________
(Attach additional training if applicable)
PLEASE INDICATE IF YOU WOULD LIKE TO BE CONSIDERED FOR THE ADR MEDIATION PANEL:
☐ Yes, I would like to be considered
☐ No, I do not wish to be considered
PLEASE INDICATE IF YOU WOULD LIKE TO BE CONSIDERED FOR THE ADR ARBITRATION PANEL:
☐ Yes, I would like to be considered
☐ No, I do not wish to be considered
Revised 11/7/14
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522A
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Parent category: Legal