NYC Bar Association: NYS Unified Court System ADR Initiative Self-Identification Form
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Name (first and last) *
Business name/entity, if any
Preferred business address *
Preferred phone number *
Preferred email address *
1.  For how many years have you actively practiced law? *
2.  In what year were you admitted to the NY Bar? *
3.  Are you currently in good standing with the NY Bar? *
Required
4(a).  What practice area specialization(s) or expertise do you consider yourself to possess? *
4(b).  What non-law experiences do you have that you think is relevant to your skills and experience as a neutral?
4(c).  What neutral work have you done or are interested in doing?
5.  How many years have you served as a neutral?
Clear selection
6.  When was your most recent service as a neutral?
Clear selection
7.  In how many matters have you served as a neutral?
Clear selection
8.  In what types of matters have you generally served as a neutral?
9.  Have you completed 40 hours of mediation training under Part 146 of the Rules of the Chief Administrative Judge?
10.  If you answered yes to Question 9, where did you complete your 40 hour training?
11(a).  What other mediation/ADR training have you completed (include provider, subject matter and year completed)?
11(b).  If you are currently in a program leading to certification, please identify the program and expected date of completion.
12.  List all US ADR rosters or panels to which you have been admitted and are in good standing (identify by court and/or administering organization)
13.  Are you certified to mediate through a Community Dispute Resolution Center?
14.  If you answered yes to Question 13, which Community Dispute Resolution Center, when were you certified?
15.  Indicate which languages other than English that you speak
16.  Please indicate any other languages that you speak not included in Question 15
17.  In which languages are you able to serve as a neutral (or have previously served as a neutral)?
18.  Indicate all New York Counties in which you would be available to serve as a neutral
19.  Indicate court/case type for which you seek to serve as a neutral
20. Please provide any additional information that you would like the NYS Unified Court System to know.
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