Mediator Application Form

Please fill out the following application. Contact with any questions.

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  1. been part of any civil, criminal or administrative proceeding charging you with conduct involving dishonesty, unethical conduct or commission of a crime? or
  2. been disciplined or cited for a breach of ethics or unprofessional conduct by any court, administrative agency, bar association, or other professional group, excluding sanctions in an amount less than $1,000, imposed against you in a civil proceeding?


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