Mediators Online Application

U.S. BANKRUPTCY COURT FOR THE WESTERN DISTRICT OF PENNSYLVANIA

           

HELP
If you have ever been appointed to the Bankruptcy Mediation Program in U.S. Bankruptcy Court for the Western District of Pennsylvania DO NOT submit this form.
Please use the Annual Application Renewal process.
Demographics Section
First Name: *
Middle Name/Initial:
Last Name: *
Legal Firm Name: *
Email Address: *
Email Confirmation: *
Primary Phone: *
Alternate Phone:

Office Area *
Office: Erie
Johnstown
Pittsburgh

Experience *
Type: Bankruptcy Including Appeals
Construction
Divorce/Support
Labor
Other:

Compensation *
Type Rate (format: 1,100.00) Type Rate (format: 1,100.00)
Hourly Half Day
Daily Flat Fee

Mediator Profile Information Section
Enter a paragraph of information to appear on your mediator profile.
Enter a paragraph describing your training that will appear on your mediator profile.

Document Upload Section (PDF format ONLY)

Attach your completed PAWB Local Bankruptcy Form 31: *


    * Denotes required information