APPLICATION FOR COURT ROSTER MEDIATORS
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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
Prefix
First Name
Middle Name
Last Name
Seniority
Primary Phone
Email Address
Address Line 1
Address Line 2
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
District of Columbia
Zipcode
Website/Online profile
2.
Business/Firm/Organization Information
(if you are an attorney, please be sure this information matches your New York State attorney registration information)
Business Name
Business Address
Business City
Business State
Business Zip
Business Website
Education
3.
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).
Institution
Degree
Graduation Year
Major
1
Institution
Degree
Graduation Year
Major
2
Institution
Degree
Graduation Year
Major
3
Institution
Degree
Graduation Year
Major
4
Institution
Degree
Graduation Year
Major
5
Institution
Degree
Graduation Year
Major
6
Institution
Degree
Graduation Year
Major
Professional Background
4.
Are you an attorney?
Yes
No
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