Northern Kentucky University NKU Alternative Dispute Resolution Center
Request for Arbitration

The parties named below hereby submit the following dispute to be arbitrated by an arbitrator of the NKU Alternate Dispute Resolution Center. These parties agree to waive their rights to a trial before a judge or jury and to abide by and perform any award rendered by the arbitrator. These parties understand that a judgment upon the arbitration award may be entered in any court having jurisdiction. If the parties already have agreed to arbitration, a copy of that arbitration agreement must be attached.
  Party 1 Counsel( if any) for Party 1
Name
Address
City/State/Zipcode
Phone
Email
Signature ___________________________________________________ ___________________________________________________
     
  Party 2 Counsel( if any) for Party 2
Name
Address
City/State/Zipcode
Phone
Email
Signature

___________________________________________
To be completed on printed copy.

____________________________________________
To be completed on printed copy.
     
Nature of Dispute
Amount of Claim or Relief Sought by Party 1
Amount of Claim or Relief Sought by Party 2
     
You may select an arbitrator.
We have conferred and agreed to request the following arbitrator:
       Meet our arbitrators.
        Select an arbitrator.    
We request that the NKU Alternate Dispute Resolution Center assign an arbitrator to this case.
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Arbitration Provider Agreement
To be completed on printed copy.

____________________________________________________, Arbitrator, through the auspices of the Alternate Dispute Resolution Center, agrees to arbitrate the above dispute. ______________________________________ and ______________________________________, parties to the dispute, agree that their dispute will be decided by Arbitrator, and further agree to the Arbitration Rules previously provided by the Arbitrator. Arbitration fees are agreed as follows, subject to reallocation by the Arbitrator as provided in the NKU Alternate Dispute Resolution Center Arbitration Rules:
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_____________________________________________________ _____________________________________________________
Signature, Party 1 Date
_____________________________________________________ _____________________________________________________
Signature, Party 2 Date