FORM 25. Mediator Application Form 25 (p. 1) 

March 2021

UNITED STATES COURT OF APPEALS 

FOR THE FEDERAL CIRCUIT

APPELLATE MEDIATION PROGRAM: MEDIATOR APPLICATION

Mediators and applicants must not be in active practice as defined by the Federal 

Circuit Appellate Mediation Program Guidelines. Mediators are not paid for their 

services but are reimbursed by the court for minor out-of-pocket expenses such as 

photocopying costs, telephone charges, facsimile charges, and transportation to the 

courthouse. Mediation proceedings may be held in the courthouse if desired. 

Reimbursement for reasonable travel and lodging expenses of the mediator is 

assumed by the litigants if the mediator must travel to conduct the mediation. 

Candidate Information:

Name: 

Address: 

Phone Number: Email Address: 

1. I am, and have been, a member in good standing of the bar of the following

states or the District of Columbia (add extra pages if necessary):

State: Date of Admission:

State: Date of Admission:

State: Date of Admission:

2. I am admitted to practice before the bar of the United States Court of Appeals

for the Federal Circuit.

 Yes No Date of Admission: _________________ 

 If retired, I retired from the practice of law on: _________________

3. I have a working knowledge of the Federal Circuit’s practices and procedures

based on the following:

4. I have not been disciplined by a court bar, a state bar or the District of

Columbia, or the bar of an administrative agency, had a professional license

revoked, or been convicted of a felony. (If yes, explain on an attached sheet.)

Yes No
FORM 25. Mediator Application Form 25 (p. 2) 

March 2021

5. I am experienced with the mediation process, having at a minimum (1)

represented clients in at least 2 mediations or served as a mediator in at least 2

mediations; and (2) obtained at least 24 hours of CLE-accredited or courtapproved mediation training. Please indicate any other experience that you

believe is relevant: (If no, explain why you are otherwise qualified.)

Yes No

6. I am willing to attend mediation training on my own before being assigned as a

mediator.

Yes No

 I am willing to attend court-sponsored mediation, if available.

Yes No

7. Please outline any previous judicial experience.

8. List additional relevant experience including: (1) professional organizations and

any leadership positions held; (2) relevant additional degrees or licenses; and (3)

speaking or teaching about mediation (attach additional pages if necessary):

9. I confirm that I am not in active practice as defined by the Appellate Mediation

Program Guidelines at the present time.

Yes No

 The following explains why I believe I am not in active practice.
FORM 25. Mediator Application Form 25 (p. 3) 

March 2021

10. I understand that mediators in the Federal Circuit Appellate Mediation

Program will not be compensated for their services. I am willing to serve as a

mediator on this pro bono basis.

Yes No

11. If selected to be a pro bono Federal Circuit mediator, I expect my level of

participation to be:

12. I have practice experience in the following areas (check the appropriate boxes):

Customs or International Trade Personnel Law

Patent Litigation Patent and Trademark Office

Government Contracts Veterans Law

Other: _____________________________________________________________

13. Add any additional information that you wish to bring to the attention of the

Federal Circuit.

Date: _________________ Signature:

Please mail the completed form to 

Federal Circuit Bar Association 

1620 I Street, NW, Suite 900

Washington, DC 20006 

AND

Circuit Mediation Administrator

U.S. Court of Appeals for the Federal Circuit

717 Madison Place, NW

Washington, DC 20439