Chester Cnty. C.P. Rule 1915.11-1.A.b4i Form

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Form 15 See CCRCP 1915.11-1.A.(b)(4)(i): form req’d by CCRCP 1915.11-1.A(b)

AFFIDAVIT – ATTORNEY

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.

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See CCRCP 1915.11-1.A.(b)(4)(i): form req’d by CCRCP 1915.11-1.A(b)

5. _________ I acknowledge that I may not charge more than $300 per hour (although I may

charge less), nor require more than a $1000 initial retainer. My hourly rate for Parenting

Coordination is: $____________.

6. ________ I acknowledge I must accept one pro bono PC appointment for every 2 fee-

generating 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.

7. ________ I have read Pa.R.C iv.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.