Neutral Facilitator Membership Application – Tampa Bay Academy of Collaborative Professionals

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Neutral Facilitator Membership Application

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Neutral Facilitator Membership Application

Neutral Facilitator Membership Application

All Applicants Must: ¹

•Have participated in at least three collaborative cases, including at least one as a team member. The other two may be as a team member or as an observer. The three cases may include pro-bono and modest means matters.

•Have successfully completed a minimum of one 2-day Basic Interdisciplinary Collaborative Family Law Training Program.

•Undergo an interview with the membership committee.

•Be sponsored by two (2) TBACP members, one of which must be a member of the applicant’s profession, and neither of which may share the applicant’s employer.

•Hold membership in the International Academy of Collaborative Professionals.

•Complete the standardized membership application for their profession.

•Complete at least (1) 30-hour approved mediation course, unless exempted by committee due to substantial experience.

Facilitators/Mental Health Neutral Applicants Must:

•Hold an MHP licensure in the state of Florida in good standing. A member must have the highest ethical standards in both their personal and professional lives.

• Have a minimum of five (5) years of practice experience working with family systems and divorce.

•Complete an approved parent coordination training course.

¹ Meeting all of the membership criteria does not guarantee an invitation to membership in TBACP. Membership is selective and involves a confidential, discretionary, and non-appealable process.

Neutral Facilitator Membership Application Criteria

I BASIC INFORMATION

Applicant Name:

Business Name:

Address:

City:

State:

Zip Code:

Phone:

Email:

Website:

Please select the MHP disciplines in which you hold a Florida license:

PsychologistMarriage & Family TherapyMental Health CounselorClinical Social WorkPsychiatristOther

If you selected "other", please list the discipline below:

What is your Florida license number or numbers?

When were you first licensed to practice as an MPH in the State of Florida?

Are you currently in good standing within your licensed discipline?YesNo

Are you a member of the International Academy of Collaborative Professionals?YesNo

Have you had any prior disciplinary actions by the Florida Department of Business and Professional Regulation resulting in a finding of just cause?YesNo

If yes, please state the year and describe.

II SPONSORS (TBACP MEMBERS)

Sponsor #1 Name:

Firm Name:

Address:

City:

State:

Zip Code:

Phone

Profession:

Sponsor #2 Name:

Firm Name:

Address:

City:

State:

Zip Code:

Phone

Profession:

III COLLABORATIVE LAW TRAINING:

Basic Training

Date:

Number of Hours:

Place/Sponsoring Organization:

Instructor(s):

Additional Basic Training

Date:

Number of Hours:

Place/Sponsoring Organization:

Instructor(s):

Intermediate and Advanced Training

Date:

Number of Hours:

Place/Sponsoring Organization:

Instructor(s):

IV MEDIATION TRAINING

Date:

Number of Hours:

Place/Sponsoring Organization:

Instructor(s):

V PARENT COORDINATION TRAINING

Date:

Number of Hours:

Place/Sponsoring Organization:

Instructor(s):

VI COLLABORATIVE EXPERIENCE

How many total collaborative law cases (i.e. with signed participation agreements) have you handled?:

Please provide details of three collaborative cases, with signed Participation Agreements, in which you have participated: (Client names and case numbers redacted)

Collaborative Case #1

Were you the facilitator or were you an observer?

Approximate date of commencement:

Approximate date of conclusion:

Nature of the matter (i.e. divorce, post-judgment matter, etc):

Names and roles of all other collaborative professionals or observers:

Collaborative Case #2

Were you the facilitator or were you an observer?

Approximate date of commencement:

Approximate date of conclusion:

Nature of the matter (i.e. divorce, post-judgment matter, etc):

Names and roles of all other collaborative professionals or observers:

Collaborative Case #3

Were you the facilitator or were you an observer?

Approximate date of commencement:

Approximate date of conclusion:

Nature of the matter (i.e. divorce, post-judgment matter, etc):

Names and roles of all other collaborative professionals or observers:

VII MOTIVATION FOR APPLICATION

Why do you want to become a part of the Tampa Bay Academy of Collaborative Professionals?

VIII ACKNOWLEDGMENT

By making this application, you agree that if you become a TBACP member, you will:

Regularly attend general membership meetings and have no more than two unexcused absences per fiscal year (June 1-May 31.) Written notice and explanation must be submitted within 30 days to the Board for consideration of requests to be excused.
Participate in or observe at least one (1) collaborative case (including pro bono) each fiscal year.
Attend at least eight (8) hours of continuing education in collaborative practice, conflict resolution, or interest-based negotiations each fiscal year OR participate in or observe a second collaborative case.
Maintain continuous membership in the IACP. • Agree to and reaffirm the mission of TBACP.
Maintain Florida Bar membership in good standing and notify the Co-Chairs in writing of any change.
Notify the Co-Chairs in writing of any grievance proceedings which result in private or public reprimand, suspension, or disbarment.
Adhere to TBACP practice protocols.
Pay all dues or other assessments within thirty (30) days of billing or other notification in writing.
Provide annual or any other required reporting of compliance with all ongoing requirements for TBACP membership, recognize that the requirements may change from time to time, and agree to maintain up-to-date familiarity with these and all requirements listed on the Members section of the TBACP website.

By signing this application, you are representing that the above information is true and correct to the best of your knowledge. You also agree to all membership requirements and recognize that if you become a member of TBACP, select membership privileges or membership itself may be suspended upon failure to comply with all requirements of membership.

Signed:

Date

WHY COLLABORATIVE?

WHAT IS TBACP?

WHERE DO I START?

MISSION STATEMENT

To create a community in which our members refine their collaborative skills through education, resource sharing and mutual support, in order to promote excellence in the practice of collaborative law, and thereby preserve the privacy, dignity and peace of divorcing couples and families in the Tampa Bay area and beyond.

NOTICE

TBACP is a non-profit association of independent professionals, not a law firm; the information provided on this site is provided for educational purposes only and does not constitute legal advice.

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