APPLICATION FOR MEMBERSHIP AND ACCREDITATION
NZLS PANEL OF MEDIATORS – FAMILY SPECIALISTS
Full name:
NZLS Lawyer ID:
(6-digit number on your practising certificate)
Telephone:
Email:
1. QUALIFYING CRITERIA

1.Are you a full member of the Family Law Section?YES NO

2.Have you successfully completed the following NZLS CLE Ltd training:

Lawyer for the Child: year completed: ______YES NO

Mediation for Lawyers (A): date on certificate:* ______YES NO

Mediating in the Family Court (B): date on certificate: ______YES NO

*I was exempted Part A by NZLS CLE Ltd/Massey University.YES

If you have not completed the above NZLS CLE Ltd training, please use the separate

application form to have your alternative qualifications assessed.

3.Have you practised in the NZ Family Court for at least 5 years?YES NO

If you ticked no, please complete a summary of your experience using the assessment guide

in 3. below.

2. DECLARATION

I declare that the information I have provided in this application form is true and correct.

I have read the NZLS Guidelines for Mediators.

Signature: ______Date: ______

PUBLICATION

I want my Panel membership to be listed in the FLS website directory YES NO

PANEL MEMBERSHIP & ACCREDITATION APPLICATION FEE - $201.25 (GST incl.)

A paid tax invoice will be sent to you after the payment is banked.

PAYMENT OPTIONS

Option 1:Cheque - I enclose a cheque made payable to the “NZLS Representative Services”

Option 2:Direct creditASB Bank: 123140-0119103-00

Reference: Your last name

Please email notification to:

Option 3:Credit card - Please charge $201.25 to my credit card:

Type of Card: Visa Mastercard

Card Number:

Expiry Date:_____ / _____ 3 Digit security number on the back of your card

SIGNATURE: ______DATE: ______

3. ASSESSEMENT GUIDE – EQUIVALENT RELEVANT EXPERIENCE

This part only needs to be completed if you answered NO to question 3.

If you do not have 5 years practising as a lawyer in the NZ Family Court, you will

need to demonstrate you have the equivalent relevant experience of working with

families in conflict. Please:

Briefly describe you skills, knowledge and experience in relation to each of the

criteria below:

(a)The number of years you have practised in the NZ Family Court

(b)The proportion of time you spend practising Family Law;

(c)Family systems theories and child development;

(d)Gender issues;

(e)Domestic violence and power imbalances and how to deal with unequal barganinig positions;

(f)Dealing with highly emotional clients;

(g)The challenges of dealing with unrepresented clients;

(h)Community-based organisations and support groups offering families help; and

(i)Demonstrate an awareness of cultural and disability issues.

Limit your self assessment knowledge to approximately 300 words for each criteria.

Attach your self assessment form to this application form (a form is provided below).

Please provide the name and contact details of two referees who the NZLS may contact to provide professional comment your application.

Reference One

Name: ______

Relationship to applicant: (e.g. supervising partner) ______

Phone: ______

Email: ______

Reference Two

Name: ______

Relationship to applicant: (e.g. supervising partner) ______

Phone: ______

Email: ______

Briefly describe you skills, knowledge and experience in relation to each of the criteria

below (limit to 300 words):

(a)The number of years you have practised in the NZ Family Court
(b)The proportion of time you spend practising Family Law
(c)Family systems theories and child development
(d)Gender issues
(e) Domestic violence; power imbalances and how to deal with unequal barganing positions
(f) Dealing with highly emotional clients
(g) The challenges of dealing with unrepresented clients
(h) Community-based organisations and support groups offering families help
(i) Demonstrate an awareness of cultural and disability issues