Chest. Cnty. Ct. Comm. Plea. R., form 16
I,_________________, the undersigned applicant, hereby certify that I possess the minimum qualifications to serve as a Parenting Coordinator as established by Pa.R.Civ.P. 1915.11-1.(b)(1),(2), as follows:
1. _____I am licensed to practice in the Commonwealth of Pennsylvania. My Attorney ID number is______.
_____My license is in good standing.
_____ I have never been subject to attorney discipline. (If Applicant has been subject to discipline, provide details on separate sheet).
_____ I have practiced Family Law for_____years, as follows (or attach CV):
_______________________________________________
_______________________________________________
_______________________________________________
2. _____I have obtained the special training required by the Rule and have attached verification for each training:
_____hours in the Parenting Coordination process, of which 2 or more hours were specific to Pennsylvania PC practice.
Date of training:_________________
Provider:_________________
_____hours of Family mediation (or hours of non-specific mediation training and hours of Family Mediation conducted).
Date of training:_________________
Provider:_________________
_____hours of Domestic Violence training.
Date of training:_________________
Provider:_________________
3. _____I understand that to remain qualified as a Parenting Coordinator in each 2-year period after March 1, 2019, I must take a minimum of 10 additional continuing education credits, of which at least 2 must be on domestic violence.
4. _____I maintain Professional Liability insurance of $______, which coverage expressly covers me for serving as a Parenting Coordinator. The Declaration page showing the foregoing is attached.
5. I acknowledge that I may not charge more than $350 per hour (although I may charge less), nor require more than a $1,500 initial retainer. My hourly rate for Parenting Coordination is: $______.
6. _____I acknowledge I must accept one pro bono PC appointment for every 2 feegenerating appointments in this judicial district/county, up to 12 hours per pro bono case. I understand that it is my responsibility to advise the court upon acceptance of the second appointment. I further understand that failing to accept a pro bono assignment or to notify the Court is grounds for removal from the roster maintained by this county. My obligation to provide pro bono work is ongoing and does not expire in the event I do not receive a pro bono case.
7. _____I have read Pa.R.Civ.P. 1915.11-1 and understand the scope (and) limits of my authority and the procedures which I must follow when appointed as a Parenting Coordinator.
8. _____I acknowledge that I have read the Guidelines for Parenting Coordination promulgated by the American Psychological Association and Association of Family and Conciliation Court. https://www.apa.org/practice/guidelines/parenting-coordination
https://www.afccnet.org/Resource-Center/Practice-Guidelines
I swear or affirm that the foregoing statements are true and correct.
APPLICANT:
Name (printed)_________________
Signature_________________
Date:_________________
FOR OFFICIAL USE ONLY
Qualifications Reviewed by:_____(initials)
Place application on Roster:_____ _____
Yes
No
If No, state reasons:
J.
Chest. Cnty. Ct. Comm. Plea. R., form 16