Mental Health Litigation Division Civil Commitment Certification Training. Nov. 2, 3 and 17, 2017

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1 Mental Health Litigation Division Civil Commitment Certification Training Nov. 2, 3 and 17, 2017 The CPCS Mental Health Litigation Division is now accepting applications for its 3 day Civil Commitment Certification Training taking place November 2, 3 and 17, The training will be held at the Brockton CPCS office, 144 Main Street, 1 st floor conference room on the following dates: Thursday, November 2, 2017 from 9:00 am to 4:30 pm Friday, November 3, 2017 from 9:00 am to 4:30 pm Friday, November 17, 2017 from 9:00 am to 4:30 pm To apply, please submit the attached application. Deadline to submit the application is October 12, Applicants to the program must be accepted prior to registering for the training. For further information about the Mental Health Litigation Division Civil Commitment Certification Training process, please contact Joe Robinson at , jrobinson@publiccounsel.net or Paulette Marie at , pmarie@publiccounsel.net

2 The Commonwealth of Massachusetts Committee for Public Counsel Services Mental Health Litigation Division 44 Bromfield St., 2 nd Fl., Boston, MA ANTHONY J. BENEDETTI CHIEF COUNSEL TEL: FAX: MARK A. LARSEN DIRECTOR APPLICATION FOR MENTAL HEALTH LITIGATION DIVISION CIVIL COMMITMENT CERTIFICATION Please submit the following form & information, by , to: Joseph Robinson, Trial Panel Director Mental Health Litigation Division jrobinson@publiccounsel.net 1. Name: Law Firm: Office Address: Office Telephone: Office Fax: Address: 2. Date of admission to MA Bar: BBO Number: Membership in Other Bars: Jurisdiction: Admission Date: Membership #: Law School(s) and date of graduation: 1

3 3. Please submit resume describing education and employment history. 4. Please list five most recent trials which you have conducted as lead counsel, including the name of case, duration of the trial, the court in which it was tried, judge, opposing counsel, and nature of the case. If fewer than five trials were conducted in the last five years, please describe significant evidentiary hearings or appellate proceedings in which you have participated. 5. Please describe experience in utilization of expert witnesses at trial. 6. Please list participation in specialized trial skills training programs (e.g., MCLE) within the last five years including sponsors, locations and dates. 7. Please list participation in other training programs within the last five years, including sponsors, locations and dates. 8. Please describe all education and/or experience representing or working with persons with disabilities. 2

4 9. Have you ever been disbarred, suspended, reprimanded, censured, or otherwise formally disciplined publicly or privately, as an attorney, or as a member of any other profession, or as a holder of any public office whether in Massachusetts or elsewhere? Yes No If yes, please explain. 10. Are any charges or complaints now pending before any court or agency concerning your conduct as an attorney, or as a member of any profession or as a holder of any public office? If yes, please explain. Yes No If yes, please explain. 11. Have you previously served on any other panel or list for assignment of lawyers to represent indigent clients? Yes No If so, list each panel and list the dates of your service. 12. Have you ever been removed from or suspended or otherwise disciplined by any panel for any period? Yes No If yes, give particulars. 3

5 13. Do you speak any foreign languages? Yes No If yes, give particulars, and describe your level of fluency. 14. The Committee for Public Counsel Services is committed to assuring that the panel of attorneys accepting MHLD assignments is sensitive to the diversity of the client population it serves. What background, experience and perspectives would you bring to the panel which would further the goal of maintaining a diverse panel that provides high quality legal representation? 15. Please briefly state the reasons you would have applied for membership on the MHLD panel and briefly furnish any other information which you think would be helpful to the Committee for Public Counsel Services in evaluating your application. 16. Please enclose a short, concise legal writing sample. 4

6 I hereby certify that the above information is true and correct. SIGNATURE: DATE: 5