Mediator Application

• Legal Form Number: 25
• Date: 01 March 2021
• Court: U.S. Court of Appeals — Federal Circuit
• Section: United States Court of Appeals for the Federal Circuit

FORM 25. Mediator Application Form 25 (p. 1)

March 2021

UNITED STATES COURT OF APPEALS

FOR THE FEDERAL CIRCUIT

APPELLATE MEDIATION PROGRAM: MEDIATOR APPLICATION

Mediators and applicants must not be in active practice as defined by the Federal

Circuit Appellate Mediation Program Guidelines. Mediators are not paid for their

services but are reimbursed by the court for minor out-of-pocket expenses such as

photocopying costs, telephone charges, facsimile charges, and transportation to the

courthouse. Mediation proceedings may be held in the courthouse if desired.

Reimbursement for reasonable travel and lodging expenses of the mediator is

assumed by the litigants if the mediator must travel to conduct the mediation.

Candidate Information:

Name:

Address:

Phone Number: Email Address:

1. I am, and have been, a member in good standing of the bar of the following

states or the District of Columbia (add extra pages if necessary):

State:

Date of Admission:

State: Date of Admission:

State: Date of Admission:

2. I am admitted to practice before the bar of the United States Court of Appeals

for the Federal Circuit.

Yes No Date of Admission: _________________

If retired, I retired from the practice of law on: _________________

3. I have a working knowledge of the Federal Circuit’s practices and procedures

based on the following:

4. I have not been disciplined by a court bar, a state bar or the District of

Columbia, or the bar of an administrative agency, had a professional license

revoked, or been convicted of a felony. (If yes, explain on an attached sheet.)

Yes No