Mediator Qualification Questionnaire
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2APPENDIX I (L.R. 7.05)
MEDIATOR QUALIFICATION QUESTIONNAIRE
Name__________________________________________________________________
Business Address_________________________________________________________
Telephone_______________________________________________________________
List any formal post-law school training for mediation (including seminars). Include the dates of
the formal training:
List the number of cases you acted as mediator:
Check off the following areas you feel confident in mediating:
Tort
___________________
Commercial
___________________
Products Liability
___________________
Administrative Appeals
___________________
Workers Compensation
___________________
Appendix
Page 11
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