Mediator's Application Form

In accordance with Rule 9.02 of the Rules of the Middle District of Florida, I am applying for certification as a mediator with the United States District Court for the Middle District of Florida.

* denotes a required field

I qualify by the following:

  Former State Judge and Bar Member of that state
Retired Federal Judicial Officer
Bar Member of any state or DC for 10 years AND current member of USDC-FLM Bar

The following information is supplied in support of this application:

First Name: *
Middle Initial/Name:
Last Name: *
Generation: Jr., Sr., etc.
Fla. Bar ID Number:

Firm Information - Mailing Address

Firm Name:
Address Line 1: *
Address Line 2
City: *
Mailing Address Zip + 4 *


Office Phone Number: nnn-nnn-nnnn *
Cell Phone Number: nnn-nnn-nnnn
Office Fax Number: nnn-nnn-nnnn 
List names and dates of membership with any state bars or the bar of the District of Columbia:
Are you a member in good standing of the bar associations listed above? Yes  No
Date admitted to the Bar of this Court: mm/dd/yy
Date the State Supreme Court's Mediator Certification Program completed: mm/dd/yy *
Number of mediation conferences held to date: *
Check all of areas of legal practice or experience which best describes your legal background: *
Administrative Law
Business Litigation
Civil Rights
Environmental Law
Intellectual Property
Personal Injury
Personal Property
Products Liability
Professional Liability
Real Property
Social Security
Please indicate the Divisions in the Middle District in which you would be willing to serve as a mediator: *
E-mail: *
Please enter the number that appears below:
Image Please click here for an audio version of the number. *


The Middle District of Florida has adopted a Mediation Program. This Program consists of a supervised settlement conference presided over by a qualified, certified and neutral mediator to promote conciliation, compromise and the ultimate settlement of a civil action. Pursuant to Local Rule 9.02, the chief judge of the District shall certify those persons who are eligible and qualified to serve as mediators under this rule, in such numbers as the chief judge shall deem appropriate. An individual may be certified to serve as a mediator if:

  1. (1)  He or she is a former state court judge who presided in a court of general jurisdiction and was also a member of the bar in the state in which he presided; or

  2. (2)  He or she is a retired federal judicial officer; or

  3. (3)  He or she has been a member of a state bar or the bar of the District of Columbia for at least ten (10) years and is currently admitted to the Bar of this Court.

In addition, an applicant for certification must have completed a minimum of 40 hours in the Florida Circuit Court Mediation Training Course certified by the Florida Supreme Court and be found competent by the chief judge to perform mediation duties.

If you are interested in becoming a mediator for the Middle District of Florida, and meet the above requirements, please complete the application form on this web page. Questions can be directed to:

Application deadlines established by the Court are the first business days in January and July. Applications will be considered by the Court on the first deadline after submission. Applicants will be notified in writing regarding the disposition of applications, and each successful applicant will receive a copy of the Court order certifying the applicant as a mediator. Names of certified mediators are included on a roster which is available on the Court's Web site ( under Attorney Resources.


Attorney/Participant Signature

Type your full name, prefixed with "s/", in the field above to acknowledge that you have read and understand the information in this document.