Questions marked with a * are required
Thank you for your interest in serving as a mediator for the New York State Unified Court System. Please use this application to apply to be considered for mediation rosters for trial courts in the New York State Unified Court System. You may apply to one or more than one roster with this application.   
In addition to answering the questions in this application, please be prepared to upload your CV/resume and any training certificates in either a pdf or Microsoft Word format. Please note that in order to upload multiple training certificates, you will need to consolidate them into one document.    

Each applicant must fulfill the criteria outlined in Part 146 of the Rules of the Chief Administrative Judge, which establishes statewide qualifications and training requirements for neutrals serving on court rosters.  Part 146 requires that an individual must meet these 3 criteria to serve as a mediator on a court roster:   
1.      Have taken a 24-hour Part 146 Approved Initial Mediation Training or its equivalent.
2.      Have taken a 16-hour Part 146 Approved Additional Mediation Training or its equivalent.
3.      Have recent experience mediating the type of cases that the court would refer to them.    
Individual Judicial Districts (or courts) may have further requirements. Please apply only to those rosters for which you possess the required criteria.  
Final placement and periodic redesignation on any court roster is at the discretion of each Judicial District’s Administrative Judge. While roster membership will qualify a mediator to mediate certain cases, it does not guarantee that any number of cases will be assigned to a mediator. To remain on any court roster, all neutrals must attend at least six hours of continuing education relevant to their respective practice areas every two years, and be redesignated by the District Administrative Judge.  
Questions about joining a particular roster of neutrals, or regarding the status of your submitted application, should be directed to the ADR Coordinator in the corresponding Judicial District or Court.       
Answer all relevant questions completely. If you are accepted to a roster, information provided in this application will be used to create a record for you in the Statewide Mediator Directory (if one does not already exist), which is accessible and viewable to the public. PLEASE DO NOT APPLY FOR ROSTERS THAT YOU'RE CURRENTLY ON (you may check the Statewide Mediator Directory to see what rosters you're on). Please note that applications are normally reviewed on an annual basis in August/September, subject to the needs of the district.  

Thank you
General Information
1.Contact Information
2.Business/Firm/Organization Information (if you are an attorney, please be sure this information matches your New York State attorney registration information)
Please list all undergraduate, graduate, professional and/or legal degrees, the educational institutions from which the degrees were earned, and the year in which you obtained the degree(s). 
Graduation Year
Professional Background
4.Are you an attorney?