Mediator Panelist Application Template
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6SUPERIOR COURT OF CALIFORNIA
COUNTY OF SACRAMENTO
720 Ninth Street ~ Room 101
Sacramento, CA 95814-1380
(916) 874-5522
MEDIATION PANELIST APPLICATION
Please be advised that as a consequence of budget cuts, the Court no longer pays for mediators; in view of their
court-appointed status, all mediators are required to provide three hours of pro-bono services per case.
Additional hours agreed upon by the litigants are at the expense of the parties.
The Court greatly values the panel of volunteers and the benefits the program provides to the litigants, counsel,
and the Court. Thank you for your willingness to reside on the panel and submitting your application for
review.
I.
GENERAL INFORMATION
Name:
Current Occupation:
Name of firm:
Firm Address:
Telephone Number:
Length of time employed at firm?
Facsimile Number:
E-mail address:
Best time to call:
Confidential and Optional: Home telephone number:
Cell phone number:
Home Address:
II.
PROFESSIONAL EXPERIENCE
Date admitted to the California Bar: _____________________
Active
Inactive
Bar Number: _____________________
Are you a certified specialist in any area of law? Yes_____ No_____ If yes, state area of law:
Are you licensed in a profession or occupation other than the practice of law?
Yes
No
Occupation:
Licensing Agency:
State:
License Number:
Summarize professional experience, particularly during the last five years:
APPLICANT’S INITIALS: __________
Mediation Panelist Application
CV-E-MED-163 (Revised June 17, 2013)
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