SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA CLARA
BACKGROUND INFORMATION/CIVIL DIVISION ADR PANEL
Instructions: DO NOT ALTER THIS FORM IN ANY WAY. DO NOT ATTACH ADDITIONAL PAGES.
Name Phone Fax
Street or P.O. Box City Zip Code
Today’s Date:
Check each panel for which you have been accepted:
mediation neutral evaluation
1. Describe your education, including degrees and the dates received.
2. Briefly describe the ADR training you have received. For each training, give the trainer’s name, the
dates attended, and the total hours.
3. Describe the subject matter of five disputes for which you have been an ADR provider in the past
five years, with the dates. Identify the process and state whether you were a sole- or co-provider.
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4. Check your areas of substantive expertise:
Banking Health Care Partnership Disputes
Business/Contract Housing Personal Injury
Civil Rights Intellectual Property Probate - Wills
Construction Insurance Professional Negligence
Defamation Labor - Employment Real Estate
Disabilities Landlord/Tenant Securities
Elder Issues/Abuse Medical Malpractice Tax
Environment Neighborhood Other (specify)_____________
5. If you are an attorney:
A. How many years have you been in active practice? If none, please explain.
B. What is or was the nature of your practice?
C. What percentage of your practice has been representing plaintiffs_____ defendants _____?
D. How many of the following have you completed in the past five years?
Jury trials _____ Court trials _____ Judicial arbitrations _____
6. Is your ADR style facilitative or evaluative/directive?
7. Describe your fee schedule, including any sliding-scale or pro-bono provisions.
8. Give any other information that should be considered by parties or counsel.
BACKGROUND INFORMATION/CIVIL DIVISION ADR PANEL
CV-5049 REV 1/07
