Marin — CV055 / FL055

Source: https://www.marin.courts.ca.gov/system/files/cv055nfl055-applicationtoserveassettlementconfpanelist-cvnfl11-15pdf.pdf

MARIN COUNTY SUPERIOR COURT 3501 Civic Center Drive, Room 113 P.O. Box 4988 San Rafael, CA 94913-4988

Application to Serve as Volunteer Settlement Conference Panelist
for Civil Family Law

Attorney Mental Health Professional

1. Contact Information

Name: CA Professional Lic. No.:

Business address:

City: State: Zip:

Mailing address (if different):

Work No.: Home No.: Cell No.:

Fax No.: Email Address:

2. Professional and Personal Qualifications

Date of admission to the State Bar of California or date of Ph.D., MFT or LCSW licensure: Are you a party to any pending criminal, civil, small claims, family law or probate proceeding in this court? Yes No (If you answered yes, please explain in a separate attachment.) If applying as a Civil Settlement Conference Panelist, have you met the qualifications described in California Rule of Court 10.781 for court-related ADR neutrals? Yes No

3. Practical Experience

Business (Commercial/Contract) % Yes No Medical Malpractice % Yes No Family Law % Yes No Personal Injury % Yes No Labor - Employment % Yes No Probate % Yes No Legal Malpractice % Yes No Real Estate % Yes No Other:

PLEASE SEE GUIDELINES ON PAGE 2

I understand and acknowledge that serving as a volunteer settlement conference panelist is solely at the discretion of the court for the purpose of assisting the public and does not constitute an employment relationship. I am aware of and will comply with all provisions of the California Rules of Court concerning court related ADR neutrals.

If I am, or the firm/practice group in which I am an equity partner is, a party to any pending or impending litigation in the court, I understand that I cannot serve as a volunteer settlement conference panelist until such cases have been disposed. If asked to serve as a volunteer settlement conference panelist while I have cases pending, I agree to decline the appointment and notify the court. This does not apply to instances where I represent or am treating parties with pending or impending actions before the court.

I declare under penalty of perjury under the laws of the State of California that the foregoing, including statements made in all attachments, is true and correct. I understand that any misstatement or omission of material fact may disqualify me from serving as a volunteer family law settlement conference panelist in this court.

DATE APPLICANT’S SIGNATURE

CV055 / FL055 (Rev. 11/15) APPLICATION TO SERVE AS VOLUNTEER SETTLEMENT CONFERENCE PANELIST Page 1 of 2 CIVIL OR FAMILY LAW

QUALIFICATION GUIDELINES FOR PARTICIPATING AS A FAMILY LAW SETTLEMENT CONFERENCE PANELIST

Attorneys: The court suggests that participants have the following knowledge, experience or training:

Experience in litigation and/or the settlement of custody cases through mediation or the collaborative process, involving a significant number of high conflict custody disputes

Domestic Violence and the differentiation of types of domestic violence

Child Abuse, Alcohol and Substance abuse

Appointments as Minor’s Counsel

Age-appropriate parenting arrangements for divorced families

Impact of entrenched parental conflict on child adjustment

Impact of step-parents and blended families on parenting relationships

Mental Health Professionals: The court suggests that participants have the following knowledge, experience or training:

Mental Health Professional licensed in California Experience working with divorcing families, as well as experience in providing services to parents and children in high conflict families

Mediation/collaborative training and/or experience and negotiation skills Basic knowledge of Family Law and the Family Law Court system Familiarity with domestic violence, alcohol and substance abuse and potential impact on appropriate post-divorce arrangements

Familiarity with research on impact of divorce on children and families

The range of age-appropriate time-share and parenting arrangements for divorced families

Impact of separation and divorce on parents, children, parent-child relationships and quality of parenting and family dynamics

Indicators of child abuse and neglect and knowledge of related reporting laws

CV055 / FL055 (Rev. 11/15) APPLICATION TO SERVE AS VOLUNTEER SETTLEMENT CONFERENCE PANELIST Page 2 of 2 CIVIL OR FAMILY LAW