ADR-1005 Mediator Profile Form

Office of the Executive Secretary
Supreme Court of Virginia

ADR-1005 Mediator Profile Form

Use this form to request an update for your mediator profile information. You cannot update your name using this form. Follow the instructions at the end of the form to submit your request. You should receive an email confirming the update in one to two business days after submitting your request.

An asterisk (*) indicates the field is required.

Mediator Information

The following information is used to confirm your profile request. If you need to make a change to any of the information in this section, please contact DRS at disputeresolution@vacourts.gov.

Contact Information

This information will be used by OES to get in contact with you, if needed.

Phone type:
Address*:

Online Listing

The information below will be posted publicly.

Online Contact Information

Phone type:

Circuit Listing

You can choose to be listed in a judicial circuit, which will determine if and where you appear on the Court Certified Mediators (by circuit/district) map, and the Mediator Mentors (by circuit/district) map if you are a mentor. Clicking either link will take you to a map showing the circuits.

Non-English Language Proficiency

Type in each language which you are proficient in, excluding English. Click the "Add" button after each language to save it.

Services Offered

If you do not select a service from the list below, you will be listed as not accepting new clients.

Feel free to write a short description of your mediation practice to help the public and potential clients decide on a mediator. DRS will not check or edit the description for errors. DRS reserves the right to reject a description, and would notify the mediator

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Submitting this form

Print or Save and Email

Use the Print button below to print this form, which you can send to our office. Your web browser can likely "print" the page as a PDF, which you can send to our office by email. Click here for more information on how to print this page as a pdf.

Email Code

You may click the button below to generate a code which you can email to drsapplications@vacourts.gov.

Send To

Dispute Resolution Services
100 N Ninth Street, Third Floor
Richmond, VA 23219
drsapplications@vacourts.gov.