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Instructions

General Information

Your name, address, and contact information is essential for interested parties searching for a practitioner. Please include the name and indicate the type of organization that you work for, if any. Asterisked sections must be completed for your application to be processed.

Services Provided

The information provided in this section will be used as search criteria in the roster database.

• Part A. Please indicate the primary dispute resolution and consensus building services that you have experience providing. More than one box may be marked.
• Part B. Parties looking for a practitioner may have a geographic preference based on the location of the dispute. Please indicate the geographic areas where you have previous experience and knowledge. More than one box may be marked.
• Part C. Occasionally cases require special skills or services such as computer support, note taking and meeting minutes, translation and interpretation, access to technical experts, or trainers. Please mark all such resources that you or your organization can provide; this may include services that you can readily obtain through subcontractors.
• Part D. Please provide your hourly rate, and explicitly state what activities your hourly rate does and does not include. If you charge on a per-case basis, please convert your rate to an hourly rate. If you offer pro bono, reduced, or variable rates, please indicate the terms and circumstances for which you offer these rates.

Qualifying Case Experience

• Qualifying Cases
• References
• Additional Case Credit
• Detailed Case Descriptions

The following four sections are used to profile your experience in environmental dispute resolution and consensus building. The Qualifying Case, Reference and Additional Case Credit sections are used only to meet the roster qualifying criteria and for application review. These sections are not included in the practitioner profile provided to search/referral users. The primary entry criterion for the roster is 200 case hours in environmental cases.

• Qualifying Cases
  In Qualifying Cases, list a minimum of two but a maximum of ten environmental cases that in aggregate total 200 case hours. List only those cases in which you were the principal or a co-principal. List only those cases on which at least 20 case hours were expended. List only those cases that occured in the last 10 years. Environmental cases are those cases involving (prevention, cleanup, or consequences), land use, natural resource use or distribution, environmental permitting, facility or infrastructure siting disputes, environmental justice, and negotiated rulemaking, enforcement, or compliance relating to environmental cases.
  Do not include cases in which you acted as a negotiator for a party, presiding judge, arbitrator, hearing officer, or other decision-maker. Provide a descriptive case name up to 50 characters in length, state your primary ADR role in the case (only one may be chosen), provide the date that the case ended (or if the case is ongoing, please indicate as such), and estimate the number of case hours spent in each respective case. As you complete these case listings, your total number of hours will be updated and visible in a table below the form on the page. Case hours include all phases of the ADR process, including assessment, process design, meeting evaluation, reporting and time spent with individuals or parties. Do not include more than the number of cases necessary to accumulate 200 case hours. Including more has no effect.
• References
  For two of the environmental cases listed in your Qualifying Cases (see above) please provide two references for each case who can verify your role in the case. References will be checked by Institute personnel only and will not be released to other parties.
• Additional Case CreditYou must accumulate 60 points across case experience, training work, and substantive background to reach the second roster entry criterion. Points are not reported to parties searching the roster; they are used only to meet the roster qualifying criteria. Please refer to the roster entry criteria for more information.
  
  
  • Question 1: Select the choice which most accurately reflects the number of environmental and public policy cases in addition to the environmental cases used to meet the 200 hour requirement, in which you served as a principal in the last 10 years. Do not count here cases used to meet the 200 hour "Qualifying Cases" requirement.
  • Question 2: Select the choice which most accurately reflects the total number of all your complex environmental or public policy cases in which you served as a principal in the last 10 years. (Include other cases, cases counted in Question 1 and cases included in "Qualifying Cases" here if they meet the definition of complex.)
  • Question 3: To receive credit for environmental or public policy cases in which you served as an apprentice or junior professional in the last 10 years, please select the appropriate choice.
    
    
• Detailed Case Information
  This portion of the application will appear in the Practitioner Profile that searchers can print and review, and which is provided to those seeking referrals from the Institute. You may provide up to 5 descriptions of environmental cases that represent the nature and scope of your work. These five cases may be cases you listed in Qualifying Cases or may be other cases. It is helpful for application review if you describe cases listed in the "Qualifying Cases" section.

Training Hours and Training Courses

In addition to case experience, the extent of one's ADR interactive training experience can demonstrate the strength of your skills to parties looking for an ECR practitioner. Please check any of the applicable boxes and list up to six training sessions in which you have participated as either a student or an instructor. For each course listed, provide the course title, course length (in days), the year taken, and the name of the organization who provided the course, and indicate your involvement as either a trainer or a trainee. List only ADR process and training technique courses which were interactive and incorporated role plays, sumulations, and group demonstrations. This section is used to calculate points to qualify for listing on the roster and appears in the Practitioner Profile available to searchers and provided to those seeking referrals from the Institute.

Other Relevant Education and Experience

• Relevant Education
  While not required for inclusion on the roster, graduate education and program certification may be a consideration of some parties looking for a practitioner and will be included in point total to help meet the second roster entry criteria. Please list the graduate schools or certification programs that you have completed, their location, and the type of degree or certificate. Include the year that you received your degree or certificate.
• Relevant Work Experience
  In the space provided, please list your work history or voluntary professional experience in fields related to ADR/ECR, such as law, engineering, public administration, planning, etc. Please include: the name of the organization for which you worked/volunteered; whether you worked/voluteered full or part time; your position or title; and the dates you worked/volunteered (if it is a current/on-going position, leave the end date field blank. It will display and print out as "current"). Information in this section is included in the Practitioner Profile and may also help you qualify for listing on the roster.
• Languages
  If you speak languages in addition to English, please list those languages and your level of proficiency.
• Summary of Case Experience & Case Narrative
  Summary of Case Experience - Please provide the total number of environmental and public policy cases in which you have served as an environmental dispute resolution and consensus building professional in the past ten years. Of the total number of cases stated, list the average number of hours spent on each case.
  
  Case Narrative - You may include a 200-word or fewer, summative description of your experience in mediation, facilitation, and other dispute resolution services as well as your professional strengths and style of practice in the space provided. Include any relevant information that you believe would be useful to parties in determining whether you are an appropriate neutral for their dispute.

Gender, Ethnicity and Minority Affiliation Information

Please indicate relevant ethnic background, gender and minority affiliation status.

Areas of Substantive Knowledge

• Educational and Professional Experience
• Case Types
  
  

The parts in this section are included to provide an overview of the breadth of case experience and professional expertise that you offer. They are included in the Practitioner Profile.

Terms & Conditions Agreement

Applicants who qualify for the roster and wish to be listed must agree to the terms presented in this section and certify that the information presented on the application is accurate. Falsification may subject you to civil or criminal penalties as prescribed in 18 U.S. C. '1001. Click the "submit" button to indicate your acceptance of the terms and your agreement. Your application can not be considered unless and until you click "submit."