COURT OF COMMON PLEAS

DIVISION OF DOMESTIC RELATIONS

HAMILTON COUNTY, OHIO

APPLICATION FOR PARENTING COORDINATOR APPOINTMENT LIST

Pursuant to Hamilton County Court of Domestic Relations Local Rule Title II, I hereby apply for appointment as a parenting coordinator.

Name:	Telephone:

Profession:	Cell Phone:

License No.:	FAX:

Office Address:	Email:

Fee structure:

Flat fee - $ per hour per person OR couple (circle)

Other:

This application must include:

(1)	a resume stating the applicant’s education, experience, training, and expertise demonstrating compliance with the Court’s Local Rule and demonstrating the applicant’s ability to successfully perform the duties and responsibilities of the parenting coordinator. You may also include any other training or experience, including foreign language proficiency, that would be helpful in the role of a parenting coordinator;

(2)	a copy of the applicant’s certificate of completion for each required Supreme Court of Ohio training;

(3) the applicant’s original Background Disclosure Statement (DR 2.51); and

(4) a copy of the applicant’s malpractice insurance declaration page.

Incomplete applications will not be accepted and will be returned to you for completion.

I certify that the information herein is true and accurate to the best of my knowledge and belief and that I have read and understand the duties and obligations of a parenting coordinator as set forth in the Court’s Local Rules.

Signature	Date