Mediator Application

In joining our directory, you agree that clients who contact you from our website should expect to pay no more than $75 per hour with a minimum mediation session fee of $150.

How to submit your application:

The application should take less than 30 minutes to complete. Please gather the required information and documents prior to beginning this application. You will need:
1. Your resume
2. A copy of the declaration page from your current professional liability insurance policy
3. D.C. Bar number or other Bar number, if you are a lawyer
4. Email & phone information for two professional references
5. Email & phone information for two mediation client references
6. Your standard fee agreement, including charges for preparation time, if any
7. Your mediation confidentiality agreement
8. A non-refundable application fee of $50

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 1: About You
Full Name *

First Name Last Name
Your Phone Number *

Area Code Phone Number
Identify which email address you would like us to send application updates to: *
Website address (optional)

Step 2: Description of Your Services/Practice
List each major area of expertise and your respective years of experience mediating cases in that area. Please also note what type of work you do within that practice area: *
How long have you been mediating? ( i.e., 1/2018 – present). *
Please indicate the year and month you began and ended your mediation activity.
What kinds of cases do you accept? Select all/type in the kinds of cases you accept. *
If you selected other, please specify here:
Indicate which of the following characterizes your mediation style: *

I am a facilitative mediator: I do not make recommendations to the parties, give my advice or opinion as to the outcome of the case, or predict what a court would do in the case. I do not make recommendations to the parties about how to resolve the dispute. I am an evaluative mediator, which may involve emphasizing the weaknesses in each party’s case or predicting what a judge or jury would be likely to do. I may make recommendations to the parties about how to resolve the dispute. I use both facilitative and evaluative styles, depending on the preference of the parties or, if the parties have no preference, my judgment about what is best for the case.
Attach a document describing the hourly rate you will charge for clients whose incomes are between 200-400% of the federal poverty guidelines. If you offer multiple rates, clearly list out your full rate schedule and/or sliding scale fees including charges for preparation time, if any. *

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

Step 3: Mediation training
Have you taken a basic, 40-hour mediation training?

Yes No
Please describe an alternative 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. no. of hours). *
If you have never been trained in mediation, write in: None.
Please provide the name of the trainer or organization providing the 40-hour mediation training, the dates of the training and the length of training. *

Step 4: Malpractice Insurance
Do you currently have malpractice insurance of at least $100,000 per claim/$300,000 aggregate? *

Yes No

Unfortunately, you are not eligible to join our Directory.

Step 5: Upload Attachments
Attach a copy of your declaration (“dec”) page from your most recent professional liability insurance policy *

Upload a File

Cancel of
Attach 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: Press Submit to Pay 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 Other
Please specify what organization referred you to our service:
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:

Unfortunately, you are not eligible to join our Directory.

Media Consent