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TRAVIS COUNTY - CIVIL DISTRICT COURTS (Travis County Information Technology Services)

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Appointment Application 10.10.16
1
TRAVIS COUNTY - CIVIL DISTRICT COURTS
Attorney Ad Litem, Guardian Ad Litem, Mediator, and
Competency Evaluator Appointment Application
(For appointments made pursuant to TX Govt. Code §§ 74.092, 74.098, 36.004,
36.005, & 37.001, et seq.)
* Return this form to: District Judges’ Office, 1000 Guadalupe Street, Room 327, Heman Marion Sweatt Courthouse
or email to: Appointments.Fees@traviscountytx.gov
Demographic Information:
Last Name: First name:
Mailing Address:
Telephone Number: Fax Number: ________________________________
Firm Name: __________________________________________________________________
Email address:
If Applicable:
State Bar Number: I have been licensed to practice law in the State of Texas since __________
Please list all certifications or licenses with applicable dates relating to your qualifications:
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
Professional Experience and Certifications: Please check the appropriate experience, certifications, and indicate the
number of cases handled.
Type of Experience Years’ Experience No. of Cases Board Certification Date Certified
Civil litigation ______________ __________ Family law ____________
Bench trials ______________ __________ Civil Trials ____________
Family law ______________ __________ Criminal law ____________
CPS cases ______________ __________ ____ Personal Injury Trial law ____________
Appellate ______________ __________ _________________ ____________
Juvenile ______________ __________ _________________ ____________
Edu/school ______________ __________ _________________ ____________
Appointment Application 10.10.16
2
Special Skills:
Please indicate any special skills or expertise.
Language
Spanish
Vietnamese
Sign Language
Other:
Other Areas of Expertise
Social Work
Education
Mediation
Mental Health
CASA training/# of hours
____ Other: __________
Agreements & Representation:
All Kinds of Cases
By my signature below, I request appointment as (please check all that apply):
(Please refer to requirements of each on page 3 and 4 of the application.)
Attorney Ad Litem (General) Guardian Ad Litem (Family)
____ Attorney Ad Litem/Amicus Attorney (Family)
Attorney for IV-D/DRO/Contempt cases/
(does not include CPS appointments)
____ Attorney Ad Litem (Tax)
Guardian Ad Litem (Friendly Suits)
_ Mediator
Competency Evaluator
Notice of Order of Appointment
I have the ability to receive email, and I monitor all emails I receive at least every 24 hours. I agree to accept notice by
email from the District Judges’ Office of my appointment to a case. If for some reason I do not wish to undertake the
representation to which I have been appointed, I will promptly respond by email requesting that another individual be
appointed in my place. The District Judges’ Office will provide me with the name of a substituting person, however, I
must draft the order of substitution and assure that it is signed and filed. I understand that excessively frequent requests to
appoint another individual may justify my removal from the list.
When, due to vacation, illness, or workload, I do not wish to be appointed for some period of time, I may request, in
writing to the District Judges’ Office, not to be appointed temporarily. I understand that excessively frequent and/or
lengthy requests not to be appointed temporarily may justify my removal from the list.
By my signature below, I understand the District Judge’s Office will post my name as an eligible appointment for any
of the requested appointments that I have selected pursuant to Texas Gov’t Code Sec. 37.005. Additionally, such
appointment will be pursuant to Texas Gov’t Code Sec. 37.004.
I understand that I have a duty to report back to the District Judges’ Office within 1 month of the completion
of my appointment the following:
1. The number of hours I bill and my hourly rate or my flat fee arrangement in each case in which I am appointed;
Appointment Application 10.10.16
3
2. T
he total amount of compensation paid to me in each case in which I am appointed; and
3. The source of my compensation.
I understand that a failure to report the information as required above may justify my removal from the list.
Notwithstanding the foregoing, I understand that upon receiving notice of an order appointing me, I am the
attorney, guardian ad litem, mediator or competency evaluator of record unless and until an order permitting
my withdrawal is signed and filed.
Good Standing
By my signature below I certify that one or more of the following applies to me (check all that apply):
Attorney Ad Litem—General:
I am an attorney in good standing with the State Bar of Texas and I practice in Travis County. I will notify the
District Judge’s Office, in writing as soon as practicable, if I am no longer an attorney in good standing with the
State Bar, including as a result of disbarment, disciplinary action, or failure to complete required MCLE.
Attorney Ad Litem/Amicus Attorney—Family
I am an attorney in good standing with the State Bar of Texas and I practice in Travis County. I will notify the
District Judge’s Office, in writing as soon as practicable, if I am no longer an attorney in good standing with the
State Bar, including as a result of disbarment, disciplinary action, or failure to complete required MCLE. 10
hours of my certified CLE credits annually are in the Family Law/Ad Litem Attorney Appointment area.
Attorney for IV-D/DRO or Contempt cases--DOES NOT include CPS which is handled by Austin Lawyer
Referral Service
____ I am an attorney in good standing with the State Bar of Texas and I practice in Travis County. I will notify
the District Judge’s Office, in writing as soon as practicable, if I am no longer an attorney in good standing
with the State Bar, including as a result of disbarment, disciplinary action, or failure to complete required
MCLE.
Attorney Ad Litem--Tax:
____ I am an attorney in good standing with the State Bar of Texas and I practice in Travis County. I will notify
the District Judge’s Office, in writing as soon as practicable, if I am no longer an attorney in good standing
with the State Bar, including as a result of disbarment, disciplinary action, or failure to complete required
MCLE.
or email to: Appointments.Fees@traviscountytx.gov
Appointment Application 3.5.2018
4
Guardian Ad Litem-- Family:
___ I have a Master’s degree in one of the following areas: Social or Behavioral Science, Social Work,
Sociology, Psychology, Counseling or Education. I am licensed as a Professional Counselor, Social Worker,
or Marriage and Family Therapist. I have at least one (1) letter of recommendation from a Travis County
practicing attorney specifically detailing my experience and education relating to family law or CPS cases in
Travis County. I have at least three (3) years of experience in casework with children, family counseling or
mediation.
Guardian Ad Litem—Friendly Suits:
____ I am an attorney in good standing with the State Bar of Texas and I practice in Travis County. I will notify the
District Judge’s Office, in writing as soon as practicable, if I am no longer an attorney in good standing with the
State Bar, including as a result of disbarment, disciplinary action, or failure to complete required MCLE.
Mediator:
____ I am a mediator and all of my professional mediator certifications and/or licenses are current. I have
completed the 40 hour basic training course provided through the Dispute Resolution Center or another
program or experience providing similar training. I have completed a minimum of five (5) mediations
involving Travis County cases.
Competency Evaluator:
I am a physician or psychologist who is licensed and certified in this state and who performs examinations to
d
etermine whether an individual is incapacitated or has an intellectual disability for purposes of appointing a
guardian for the individual. All of my professional competency evaluator certifications and/or licenses are
current.
Signature: Date:
* Fees for Appointments.
(a) In cases where the appointees are paid by the County, the rate is $75/hour unless the Court makes a finding that a higher
fee is justified under the circumstances.
(b) In cases where the appointees are to be paid by the Parties, the rate is $75/hour, unless otherwise agreed by the Parties
or the Court makes a finding that a higher fee is justified under the circumstances.
* Return this form to: District Judges’ Office, 1000 Guadalupe Street, Room 327, Heman Marion Sweatt Courthouse
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Completed 18 July 2020

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