Fillable MA Program Re-Application for Existing ADR Programs

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MA Program Re-Application for Existing ADR Programs

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BROWSE COMMONWEALTH OF MASSACHUSETTS (MA) FORMS

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PROGRAM RE-APPLICATION FOR EXISTING PROGRAMS
COVER SHEET
PROGRAM INFORMATION
Name: __________________________________________________________________
Address: __________________________________________________________________
Phone #: __________________________________________________________________
Fax #: __________________________________________________________________
E-Mail: __________________________________________________________________
Contact Person: ________________________________________________________________
Year Program Began: ____________________________________________________________
Number of Neutrals on Program Roster: _____________________________________________
CERTIFICATION
I certify the following with regard to the above-named program: that it qualifies as a “program” as
that term is used in Rule 2 of the Uniform Rules; that it agrees to comply with the Trial Court Policy
on Data Collection and Record Keeping set forth in Appendix A; that it agrees to comply with the
Trial Court Complaint Mechanism set forth in Appendix B; that it agrees to comply with the Trial
Court Policy on Evaluation of Dispute Resolution Services set forth in Appendix C; that it agrees to
comply with the standards set forth in Rule 7 of the Uniform Rules; that it agrees to comply with the
standards set forth in Rule 8 and the Guidelines for the implementation of Rule 8 to ensure that
neutrals on its roster meet applicable qualification standards; that it will follow the ethical standards
set forth in Rule 9 of the Uniform Rules; and that it is in compliance with all other applicable state
and federal laws.
All the information contained in this application is true to the best of my knowledge and belief.
_______________________________ _______________________________
Signature Print Name
_______________________________ ________________________________
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EXTENTION OF SERVICES
___ As an existing program, we are seeking an extension of our previous authorization to provide
court-connected dispute resolution services to the following Court Department with no
changes. Programs are required to provide a separate application to each department.
□ Boston Municipal Court □ District Court
□ Housing Court □ Juvenile Court
□ Land Court □ Probate and Family Court
□ Superior Court
___ As an existing program, we are seeking an extension of our previous authorization to provide
court-connected dispute resolution services to the above-referenced Court Department with
the following changes (please complete all sections that apply):
CASE TYPES: As an existing program, we are seeking to change the case types (e.g.,
small claims, criminal. Regular civil, etc.) that we are authorized to provide court-
connected dispute resolution as follows:
Add the following case type(s): __________________________________________
Delete the following case type(s):_________________________________________
APPROVED LOCATION/DIVISION: As an existing program, we are seeking to be
approved to provide court-connected dispute resolution services to the following
additional court division(s):
1. _______________________________________
2. _______________________________________
3. _______________________________________
4. _______________________________________
FOR DISTRICT COURT ONLY: Programs seeking to add an additional division are required to
attach a letter of support from the first justice of that court division indicating its intension to utilize
the dispute resolution services requested.
PROGRAM APPLICATION - NARRATIVE
INSTRUCTIONS. Please review the Narrative Questions #1-15. If there have been no changes in
your answers since the last application process, please answer “no changes.” Otherwise, if your
program’s responses have changed, please indicate those changes that have taken place.
Probate and Family Court Applications: The Probate and Family Court Department is requiring
all existing programs to completely answer all questions and is not permitting programs to answer
“no changes.” Please see Section 6(E) of the Instructions for Program Application.
In addition, responses to Questions numbered 3, 4, 6, 12, 13, 14 and 15 require a copy of your written
policies on those topics.
1. Program information:
Indicate numbers and types of cases handled for each of the past three years. As part of your
re-application process, you must provide a copy of your Dispute Resolution Program
Report for the period of July 1, 2017 to June 30, 2018 for each court division served. List
all types of ADR services provided. Describe in detail the services listed on the cover sheet
which your program has previously provided to a court. Describe any special expertise your
program offers based on experience or training of neutrals on your roster. To comply with
the need for foreign languages, American Sign Language or oral interpreting, list any related
fluency on the part of your neutrals. Describe the hours your program’s services are available.
2. Space:
If approved, where will you provide services? If space is not available in a courthouse, where,
specifically, would you provide services in each division? Is the space handicapped
accessible? Describe any guidelines you have for the type of space required.
3. Methodology:
Attach a copy of your written policies in accordance with Uniform Rule 7(a) for receiving
referrals, screening referrals for appropriateness, scheduling or canceling sessions,
distributing cases among neutrals on the roster, following up after sessions and ensuring that
clients are not subject to inappropriate pressure to settle.
4. Quality Control:
Describe in detail how you evaluate your programs performance and how you monitor your
neutrals. Describe any additional steps you take to ensure the quality of services you provide.
Describe your process for assembling and maintaining the roster of neutrals, including the
methods for adding and removing neutrals in accordance with Uniform Rule 7(c).
Complaints. As to any complaints received by your program, (1) Attach a copy of your
written policy for handling complaints; (2) Attach a list describing each complaint received
since your last application along with a description of the process you used for resolving the
complaint and its outcome.
5. Record keeping:
Describe the types of records you keep and the types of data you collect.
6. Diversity:
Attach a copy of your written policy prohibiting discrimination against your staff, neutrals or
clients. Describe any policies which promote diversity as to race, gender, ethnicity,
experience, and training among your staff, your neutrals and your clients.
7. Fees:
If you plan to charge fees for any court-connected services, attach your fee schedule, including
specified criteria for fee waived or reduced fee services to be made available to indigent and
low income litigants. (Fees must be approved by the Chief Justice of the Department in which
services are provided.) Also, please see the new Fee Policy for Dispute Resolution Services
in the Appendixes as Appendix D and Section 4 of the Instructions for Program Application
regarding departmental implementation of that policy.
8. Affiliations:
Is your program, the parent or subsidiary of any other organization? If so, describe the
relationship. Does any officer or employee of the courts have an affiliation or relationship
with your program? If your program has a written policy for addressing conflicts of interest,
please attach it.
9. Divisions:
Please indicate each Trial Court Department in which your program seeks approval and each
Division within that Department in which you seek approval.
10. Roster:
Please describe the size and composition of your roster of neutrals including what percentage
meet the basic training requirements and the alternative methods requirement.
11. Neutral Qualifications:
Please describe your policies, procedures and record keeping which documents how all
neutrals on your roster satisfy the qualification requirements of Rule 8 (b) (v) of the Uniform
Rules on Dispute Resolution. In addition, denote all new neutrals on your roster since the last
approval process on Form 1 - List of Neutrals.
12. Continuing Education:
Attach a copy of your written policy on continuing education of your neutrals.
13. Continuing Evaluation:
Attach a copy of your written policy on continuing evaluation of your neutrals.
14. Court Orientation:
Attach a copy of your written policy on court orientation of your neutrals.
15. Personal Information:
Attach a copy of your written policy on safeguarding personal information. Please see
Supreme Judicial Court Rule 1:24, Protection of Personal Identifying Information in Publicly
Accessible Court Documents.
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MA Program Re-Application for Existing ADR Programs

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Completed 17 May 2020

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