Application Form
ADR Providers Directory

I. Application Information

Last Name: * First Name: * Firm Name: *
Business Address: * City: * State: * Zip: *
Business Phone: * Business Fax: Email: *
ADR 1/2 Day Fees per Hour: * ADR Full Day Fees per Hour: *
Language Proficiencies:

II. Primary Profession: Check all that apply

Attorney: Mediator: Other:
Bar Card Number is:

III. ADR Background Check all that apply

Mediation: Arbitration: Moderated Settlement Conference: Summary Jury Trial: Mini-Trial:
Number of Mediation Hours: * Date ADR Practice began (Pick First of Month if Unsure): *

IV. Statutory Training: In accordance with Texas Civil Practice and Remedies Code Sec. 154.052(a)

I have completed 40 Hours: * I have completed 24 hours Family Law: *
I agree to to accept 2 mediation referrals, (1) non-settlement week, per year, pro bono: *
I agree to complete 5 hrs. of additional ADR-related education during the following 12 mos. as a condition of my name appearing on the List of ADR Providers: *

V. Ethical Guidelines

I hereby agree to adhere to the ethical guidelines for ADR pursuant to any guidelines offically promulgated by the Texas Supreme Court or adopted by the Dallas County Bar Association, ADR Section. In the event I decide that such adherence cannot be given, I will take immediate action to remove my name form the list of ADR Providers.

* Initial Here

VI. Verification/Certification

A. Verification: Please email written evidence of your compliance with the training requirements set forth in Section 154.052(a) of the Texas Civil Practice and Remedies Code. Attachments: (1) Verification of Training (Certificate) (2) Resume (2 pages)

B. Certification: "I hereby certify that the above information, and any information contained on the accompanying attachments, is within my personal knowledge to be true and correct."

* Applicant's eSignature (Please type your full name and Bar card number)

VII. Verification/Certification Please check all that apply

Code Area Practice Mediate Code Area Practice Mediate
ADL Administrative Law ADM Admiralty
ANT Antitrust APP Appellate Law
AVI Aviation BAN Bankruptcy
BT Business Torts BUS Business/Commer/Contra
CON Consumer/DTPA CRE Creditor/Debtor
CST Construction CVR Civil Rights
CY Community ED Eminent Domain
EL Election EMP Employer/Employee
ENV Environmental FAM Family Law
HLT Health INS Insurance
INT International IP Intellectual Property
JUV Juvenile LAB Labor
LIB Libel/Slander/Defamat LLT Landlord/Tenant
OG Oil & Gas/Energy PAR Partnership
PI Personal Injury PLL Prof. Liability-Law
PLM Prof. Liability-Medical PLO Prof. Liability-Other
PRL Product Liability PRO Probate
RE Real Estate REG Regulatory/Governmental
SEC Securities SP Sports
TAX Tax WC Worker's Compensation