DC Refers Mediator Application

Our online directory is open to mediators who offer mediation services to modest-means clients. Modest-means clients are clients with annual incomes between 200%-400% of the Federal poverty levels.

Step 1: Agree to Terms and Conditions
You agree to promptly let a prospective client know whether or not you have accepted them as your client. *

Yes
You agree to enter into a written fee agreement with clients. *

Yes
You understand that our DC Refers may ask your clients to evaluate your services. *

Yes
You understand that you must conduct your mediation practice in accordance with the District of Columbia Uniform Mediation Act (https://code.dccouncil.us/dc/council/laws/docs/16-87.pdf). *

Yes
You agree to contact us if you want to temporarily or permanently remove your profile from our site. *

Yes
You agree to remit to DC Refers a fee of $50 to apply to join DC Refers. *

Yes
You agree to complete periodic surveys or evaluations of DC Refers. *

Yes
You understand that not complying with any of the above terms is grounds for removal from this directory. Additionally, you understand that you can be removed from the directory for cause. *

Yes
You agree to indemnify and hold harmless the DC Refers Board of Directors and its agents from any claim, loss, damage, expense or injury to any person, or property of any person, injured through any negligence committed, omissions, or acts undertaken while performing mediation services on behalf of an individual referred to you by DC Refers. *

Yes

Step 2: About You
Full Name *
Your Phone Number *

Area Code Phone Number
Identify which email address you would like us to send application updates to: *
Website address
Leave blank if not applicable
DC Bar number
Leave blank if not applicable

You are not eligible to join our directory of mediators if you do not have mediation training.

Please consider re-applying when you have completed mediation training.

Please describe the mediation training you have taken. indicate the name of the trainer or organization providing the training, the dates of the training and the length of the training (i.e. number of hours). *

Step 5: Upload Attachments
Attach a copy of your client mediation services agreement/ your mediation confidentiality agreement *

Upload a File

Cancel of
Attach a copy of your fee schedule for clients whose incomes are between 200-400% of federal poverty guidelines. *

Upload a File
Your hourly rate/rate schedule will be used internally only. Clients will not be able to see your hourly rate/rate schedule. Cancel of
Attach your resume *

Upload a File

Cancel of

Step 6: List Your References
Please provide two professional references and two client references. Examples of professional references include: fellow mediators, mediation program administrators, mediation trainers, former employers, co-workers or colleagues. Client references should be from persons for whom you performed mediation services.
Professional Reference #1 *

First Name Last Name
E-mail
Phone Number *

Area Code Phone Number
Professional Reference #2 *

First Name Last Name
E-mail
Phone Number *

Area Code Phone Number
Client Reference #1 *

First Name Last Name
E-mail
Phone Number *

Area Code Phone Number
Client Reference #2 *

First Name Last Name
E-mail
Phone Number *

Area Code Phone Number

Step 7: Final Steps (Press submit to pay application fee)
Application Fee *

Non-Refundable Application Fee $ 50.00
How did you hear about DC Refers? *

D.C. Bar website Ad in the Washington Lawyer Magazine DC Consortium List Serv A colleague
Media Consent
From time to time DC Refers highlights a member on its Facebook page and Twitter feed, or otherwise tries to increase awareness of our members and our service. If you would like to participate in these activities, please check the following box:

I give the DC Refers permission to use my name, likeness, biography and other non-proprietary information on the web, in print, and on social media for the purpose of increasing awareness of the online directory and to otherwise further the mission of DC Refers. I do not give consent.
Should be Empty:

You are not eligible to join our directory of mediators if you do not have mediation training.