Minnesota state court system adr-rule 114 neutral roster



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MINNESOTA STATE COURT SYSTEM

ADR-RULE 114 NEUTRAL ROSTER


ORGANIZATION APPLICATION FORM

7/1/12

INSTRUCTIONS:
Complete form and mail along with the $60.00 non-refundable processing fee to:
Alternative Dispute Resolution Program

120 Minnesota Judicial Center

25 Rev. Dr. Martin Luther King Jr. Blvd.

St. Paul, MN 55155-1500

adr@courts.state.mn.us
Make check payable to: State of Minnesota
Processing time is usually 2-3 weeks and a confirmation letter will be sent after approval.



SECTION 1: GENERAL INFORMATION
Organization Name:____________________________________________________
Director: ____________________________________________________________
Address: ____________________________________________________________
City/State/Zip: ________________________________________________________
Daytime Phone: (_____)__________________ Fax: (_____)__________________
E-mail: ______________________________________________________________
SECTION 2: PLACEMENT REQUEST
Indicate the neutral roster(s) for which you are requesting placement. Also, indicate below the name of the individual from your organization who has applied or been approved for that roster.
NOTE: In order for your organization to be placed on a roster, at least one individual associated with your organization must be approved for that roster. You are required to have individual neutral roster application forms on file in your organization for each of your neutrals.
Civil Facilitative/Hybrid

(Mediation, Mini-Trial, Med.-Arb., Other)


NAME:(please print)________________________________________________

Continued on next page

Civil Adjudicative/Evaluative

(Arbitration, Consensual Special Magistrate, Moderated Settlement Conference, Summary Jury Trial, Early Neutral Evaluation, Neutral Fact Finding)


NAME:(please print)________________________________________________
Family Facilitative/Hybrid

(Mediation, Mini-Trial, Med.-Arb., Other)


NAME:(please print)________________________________________________
Family Adjudicative

(Arbitration, Consensual Special Magistrate, Moderated Settlement Conference, Summary Jury Trial)


NAME:(please print)________________________________________________
Family Evaluative

(Early Neutral Evaluation, Neutral Fact Finding)


NAME:(please print)________________________________________________
SECTION 3: CIVIL LAW AREAS OF EXPERIENCE
Indicate your areas of civil law experience for listing on the Minnesota Supreme Court website’s searchable roster (you must choose at least one).
Bankruptcy/Creditor-Debtor Insurance

  • Business/Commercial Personal Injury

  • Complex Litigation/Class Actions Professional Liability/ Malpractice

  • Construction Real Estate

Employment Securities

General Civil


SECTION 4: FAMILY LAW AREAS OF EXPERIENCE
Indicate your areas of family law experience for listing on the Minnesota Supreme Court website’s searchable roster (you must choose at least one).
Adoption Parenting Time/Child Visitation

Child Custody Paternity

Child Support Post-Dissolution Matters

Dissolution/Divorce Spousal Maintenance

General Family Law Valuation of Property

Minn. Stat. § 518.1751, subd. 2(c) states that individuals who have completed the 40 hour family mediation training are eligible to serve as parenting time expeditors, subject to continuing education requirements. If you have completed the family training and would like to be listed on the Minnesota Supreme Court website as available for parenting time expediting, please check the following box. You should also contact the local court administrators if you would like to be on the county rosters pursuant to Minn. Stat. § 518.1751, subd. 2(b).


Parenting Time Expeditor

SECTION 5: COUNTY PREFERENCE
Indicate those counties in which your organization is willing to provide ADR services:
All 87 counties
All 7 metro counties (Anoka, Carver, Dakota, Hennepin, Ramsey, Scott, Washington)
The following individual counties: please circle

Aitkin

Anoka


Becker

Beltrami


Benton

Big Stone

Blue Earth

Brown


Carlton

Carver


Cass

Chippewa


Chisago

Clay


Clearwater

Cook


Cottonwood

Crow Wing

Dakota

Dodge


Douglas

Faribault

Fillmore

Freeborn


Goodhue

Grant


Hennepin

Houston


Hubbard

Isanti


Itasca

Jackson


Kanabec

Kandiyohi

Kittson

Koochiching



Lac Qui Parle

Lake


Lake of the Woods

Le Sueur


Lincoln

Lyon


Mahnomen

Marshall


Martin

McLeod


Meeker

Mille Lacs

Morrison

Mower


Murray

Nicollet


Nobles

Norman


Olmsted

Otter Tail

Pennington

Pine


Pipestone

Polk


Pope

Ramsey


Red Lake

Redwood


Renville

Rice


Rock

Roseau


Scott

Sherburne

Sibley

St. Louis



Stearns

Steele


Stevens

Swift


Todd

Traverse


Wabasha

Wadena


Waseca

Washington

Watonwan

Wilkin


Winona

Wright


Yellow Medicine


SECTION 6: SIGNATURE
I do hereby certify that the information provided in this application is true, that only neutrals who qualify under Supreme Court Rules on Alternative Dispute Resolution will participate in this program, and that, upon request, I will provide, documentation of training provided to neutrals.
_________________________________________________ _______________

Signature Date


ADR Roster – Organization Application Page 1 of 3



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