Mediation Training Application

Please fill out the form below.

First and Last Name *

Personal Email Address *

Work Email Address

Preferred Email Address *

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Work

Home Street Address *

City *

Province/State *

Postal/Zip Code *

Country *

Personal Phone Number *

Work Phone Number

Mobile Phone Number

Preferred Phone Number *

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Work
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Employer

What inspired you to apply for Mediation Training? *

How do you hope to apply the training after you graduate? *

Prior Formal Education *

Prior Work Experience *

Prior Conflict Resolution/Negotiation/Mediation training, if any, have you completed and from whom? *

Based on your prior life/education/work experience, what personal/professional qualities would you bring to the role of mediator? *

You will need a computer and a strong internet connect to attend the online classes. Do you have access to the equipment required to participate in online training? *

Our training requires full attendance and sometimes up to 4 hours of works between the Zoom Classroom Sessions. Are you able to make that time commitment at this point in your life? *

How did you hear about our Mediation Training? *

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