Circuit Court of Henry County

Mediator Application Form

Name Ross Eshelman                                                                                                                    
Office Address 104 North Gail, Clinton, MO  64375                                                                                  
                                              E-mail: eshelman@tacnet.missouri.org                                  
Telephone (660) 885-8707                  Fax    (660) 885-8708(please call prior to faxing)                 
Person to contact for referral Same                                                                                                                                  
Telephone                                               Fax                                                                                      
Date admitted to practice 1973                                                                                    
Law firm affiliation or employer Self                                                                                      
Subject areas of legal practice Personal injury; Work Comp; General Civil Litigation            
Mediation training and experience:
When and from whom did you receive mediation training?
1999; University of Missouri Center for Study of Dispute Resolution                                                                                   
What is the total number of cases you have mediated?                      2                     
Describe the type of cases which you will mediate?
All except domestic                                                                                                                                                            
Will you provide references for those upon request?                     Yes                   
If you have references which you would like to provide here, please give names, addresses and telephone numbers of
counsel, representatives or parties familiar with your mediation work.
                                                                                                                                                                                          
What rate of compensation will you charge for mediation?  Please indicate if travel time is compensable and any other charges.
$100 per hour; no charge for travel time within 100-mile radius                                                                                           
Do you normally require written submissions from the parties about their respective positions to be given to you in advance
of the mediation?   Parties'option 
All of the above statements are complete and accurate to the best of my knowledge.
/s/ Ross Eshelman 04/25/01
Mediator Date

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