Form Ap-218 - Application For Arbitrator Registry - Individuals Only Page 3
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6AP-218-3
(Rev.7-13/8)
Page 3
16. Social Security number* (Same as Item 2 on Page 1) .................................................................................................
* Your Social Security number is not subject to public disclosure according to Section 552.147, Tex. Govt. Code.
PLEASE INDICATE BELOW REGIONS AND/OR COUNTIES WHERE YOU WOULD BE
WILLING TO CONDUCT ARBITRATIONS
(Please check boxes)
To be an arbitrator statewide, check the “statewide” box only. Checking additional boxes will invalidate (cancel) the original selection.
STATEWIDE
To be an arbitrator for a designated region that covers “all” listed counties, check the “region” box only. Checking additional
county boxes within the same designated region or statewide box will invalidate (cancel) the original selection.
To be an arbitrator for designated county/counties that does NOT include the entire region, check the designated county
box(es) only. An arbitrator may select multiple county boxes throughout various regions.
An arbitrator may have the option to oversee an entire region AND individual counties from other regions. For example, an
arbitrator may oversee the Capital Region and individual counties from the Central Texas Region.
ALAMO REGION
Atascosa
Bexar
Frio
Guadalupe
Kendall
Medina
Bandera
Comal
Gillespie
Karnes
Kerr
Wilson
CAPITAL REGION
Bastrop
Burnet
Fayette
Lee
Travis
Blanco
Caldwell
Hays
Llano
Williamson
CENTRAL TEXAS REGION
Mills
Bell
Burleson
Freestone
Hill
Limestone
Robertson
Bosque
Coryell
Grimes
Lampasas
Madison
San Saba
Brazos
Falls
Hamilton
Leon
McLennan
Washington
Milam
COASTAL BEND REGION
Nueces
Aransas
Calhoun
Goliad
Jim Wells
Lavaca
Refugio
Bee
DeWitt
Gonzales
Kenedy
Live Oak
San Patricio
Brooks
Duval
Jackson
Kleberg
McMullen
Victoria
GULF COAST REGION
Walker
Austin
Chambers
Fort Bend
Harris
Matagorda
Waller
Brazoria
Colorado
Galveston
Liberty
Montgomery
Wharton
HIGH PLAINS REGION
Armstrong
Collingsworth
Garza
Hockley
Moore
Roberts
Bailey
Crosby
Gray
Hutchinson
Motley
Sherman
Briscoe
Dallam
Hale
King
Ochiltree
Swisher
Carson
Deaf Smith
Hall
Lamb
Oldham
Terry
Castro
Dickens
Hansford
Lipscomb
Parmer
Wheeler
Childress
Donley
Hartley
Lubbock
Potter
Yoakum
Cochran
Floyd
Hemphill
Lynn
Randall
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