1
ATTORNEY APPOINTMENT LIST APPLICATION
(Civil Law - Mediators)
Denton County District Courts
Name: _____________________________________ Date of Application: ____________
Bar Card Number: _________________________ Date Licensed: ____________
Business Mailing Address: ______________________________________________________
Business Physical Address: ______________________________________________________
Home Phone: __________________________ Cell Phone: ________________________
Business Phone: ____________________ Fax Phone: ________________________
Email Address: ____________________
I am requesting my name be placed on:
Civil Law - Mediators:
Are you fluent in any language other than English? Yes No
Which languages? ____________________________________________________________
If yes, do you wish to be listed as a foreign language attorney? Yes No
CHARACTER, REPUTATION AND CONFLICTS
Are you currently a member in good standing of the State Bar of Texas?
Yes No
Have you been publicly sanctioned or reprimanded by the State Bar of Texas within the last three
(3) years?
Yes No
If yes, attach decisions by the committee and, if desired, any written explanations.
Are you a magistrate, city judge, assistant city judges, or any city, county, or state official?
Yes No If yes, where and in what capacity?
______________________________________________________________________________
______________________________________________________________________________
2
Are you currently under indictment or charged with a criminal offense greater than a class “C”?
Yes No
If yes, attach a description of the charges, where they are pending and the current status.
Have you been convicted or placed on probation for any offense greater than a class “C”?
Yes No
If yes, attach copies of all final orders (or those deferring adjudication) and judgments.
Have you ever admitted, or been found, in connection with an official proceeding, to having
provided ineffective assistance of counsel?
Yes No
If yes, explain by attaching any applicable documents and, if desired, any written explanations.
EXPERIENCE
Are you board certified by the Texas Board of Legal Specialization? Yes No
If yes please provide area of law(s) you specialize in: __________________________________
Are you a current member of the Denton County Bar Association? Yes No
What percentage of your practice is solely devoted to Civil Law? __________________
How long have you been practicing Civil Law? __________________
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Requirement:
Must have conducted at least 15 hours of mediation in non-family law cases each year for the
past 3 years or have been a sitting District Judge within the past 3 years. Please list your
experience to qualify for this requirement:
Date Cause #
Style
Presiding Judge
____ _______________ ______________________________ __________________
____ _______________ ______________________________ __________________
____ _______________ ______________________________ __________________
____ _______________ ______________________________ __________________
____ _______________ ______________________________ __________________
____ _______________ ______________________________ __________________
____ _______________ ______________________________ __________________
Requirement:
Must have completed at least 40 hours of CLE in field of Mediation or equivalent experience,
prior to application. Please list your experience to qualify for this requirement:
Date Course Title Hours Credit
______ ________________________________________________ ____________
______ ________________________________________________ ____________
______ ________________________________________________ ____________
______ ________________________________________________ ____________
______ ________________________________________________ ____________
______ ________________________________________________ ____________
______ ________________________________________________ ____________
______ ________________________________________________ ____________
TOTAL HOURS ____________
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CONTINUING EDUCATION
Please list below the CLE course related to civil law you have attended over the last three years
(if you are board certified in family law you do not need to list this information):
Date Course Title Hours Credit
______ ________________________________________________ ____________
______ ________________________________________________ ____________
______ ________________________________________________ ____________
______ ________________________________________________ ____________
______ ________________________________________________ ____________
______ ________________________________________________ ____________
______ ________________________________________________ ____________
______ ________________________________________________ ____________
______ ________________________________________________ ____________
______ ________________________________________________ ____________
______ ________________________________________________ ____________
TOTAL HOURS ____________
By my signature I attest that I have read, understand and agree to abide by the duties of the
requirements of the Texas Code of Civil Procedure and the rules of ethics promulgated by
the State Bar of Texas and affirm that the information I have provided in this application is
true and correct.
______________________________________ __________________________
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