Approved, SCAO
MC 281a (3/08) CIVIL MEDIATOR APPLICATION, Page 1 of 4
MCR 2.411(E)
CIVIL MEDIATOR APPLICATION
To be eligible to serve as a general civil mediator, you must meet the training and experience criteria specified either in
MCR 2.411(F)(2) or in the SCAO Mediation Training Standards and Procedures pursuant to MCR 2.411(F)(3).
Service as a case evaluator under MCR 2.403 does not constitute a qualification for serving as a mediator. Refer to the Mediation Training
Standards and Procedures for further information about minimum qualifications.
Note: Except for Part B, the information provided in this application is available to the public for inspection.
Please type or print neatly.
1. Full name (first, middle initial, last)
2. Bar no. if applicable
P
3. Address where you can be contacted
4. Telephone no.
5. Fax no.
6. E-mail address
( )
( )
Part A: General Civil Mediator Qualifications Complete item 7 and either item 8, 9, 10, 11, or 12 as appropriate.
7.
Is this a
new application?
renewal? If renewing, complete item 12 and attach a copy of your original application.
8. Qualification through State Court Administrative Office (SCAO) Approved Training
a. SCAO-approved training completed on
. Attach copy of certificate.
Trainer:
b.
Juris doctorate. Attach copy of diploma if not a licensed attorney.
Graduate degree in conflict resolution. Attach copy of diploma.
40 hours of mediation, observation, or role-playing experience for more than 2 years before applying. Detail below. Complete
on separate page if needed.
c. Observed two general civil mediation proceedings. Specify dates and mediator names and attach verification. Do not provide party names.
d. Conducted one general civil mediation to conclusion. Specify date and name of mediator serving as supervisor and attach verification. Do
not provide party names.
9. Qualification by Community Dispute Resolution Program (CDRP) Training
a. Michigan CDRP training completed on
. Attach copy of certificate.
Trainer:
If the trainin