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Name:
*
First
Last
Email:
*
Phone Number:
*
Address:
*
Line 1
Line 2
City
State
Zip Code
Country
Emergency Contact Name and Phone Number:
*
Ethnicity:
*
Gender:
*
Age:
*
Date of Birth:
*
Why do you want to become a mediator? What are your goals/expectations?
*
What skills do you have that you think would make you a good mediator? Please describe any education, employment or life experiences that might be of value.
*
The Community Mediation of St. Mary’s County (CMSMC) is a community-based program. What experience do you have which demonstrates your commitment to the community?
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What is your understanding of the role of a volunteer community mediator?
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What other volunteer activities have you participated in over the past 12–18 months? Why did you choose these organizations or activities? What was the time commitment to that work, and are you still involved in it?
*
How did you hear about the Center and our opportunities for mediation training?
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Do you have any special skills that may be helpful in your volunteer role, such as proficiency in another language, computer skills, etc.?
*
Have you ever participated in a mediation? If so, please describe your experience.
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What food best represents conflict to you, and why?
*
Are you currently:
*
Employed Full-time
Retired
Student under 18 years old.
Student over 18 years old.
Other
If you have answered other from the previous question, please specify.
*
What times are you available to volunteer? Please indicate your availability below:
Morning:
*
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Afternoon:
*
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Evening:
*
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Please provide three personal and/or professional references.
Reference 1 Name:
*
First
Last
Reference 1 Phone Number:
*
Reference 1 Email:
*
Reference 1 Organization:
*
Reference 1 Association/Relation:
*
Reference 2 Name:
*
First
Last
Reference 2 Phone Number:
*
Reference 2 Email:
*
Reference 2 Organization:
*
Reference 2 Association/Relation:
*
Reference 3 Name:
*
First
Last
Reference 3 Phone Number:
*
Reference 3 Email:
*
Reference 3 Organization:
*
Reference 3 Association/Relation:
*
Is there anything else you would like to share with us about yourself?
*
ORIENTATION: You must attend ONE of the Orientation session.
Saturday , March 8th, 1:30pm - 3:30pm, in person at CMSMC - Leonardtown
Friday, March 19th, 6:30pm- 8:30pm, via Zoom
Tuesday, April 1st, 11:00am -1:00pm, St. Mary's Health Hub - Lexington Park & via Zoom
INTERVIEW: An interview is also required. This will be scheduled for each mediation after the Orientation Session if not completed in advance.
Mediators are required to attend the full
4
0
-
hours of mediation training (including theory, skills, and role plays), and an apprenticeship consisting of a minimum of 8 hours of observations, co-mediation, and instruction
.
All m
ediators
are required to
volunteer
at least
40 hours
per year for 2 consecutive years a
n
d at
t
e
nd at
l
e
ast
8 hours of
continuing education training, including 2 hours of ethics training, each year.
(The Centers provides free Transformative Skill Building trainings each month.)
Please, initial below:
I will attend the 40-hour training. If an emergency arises and I miss any part of the training, I understand that I may not receive credit for completing the course.
*
I commit to attending at least 8 hours of continuing education training annually.
*
I will volunteer 40 hours a year for 2 years.
*
As a mediator I will keep confidentiality of all mediations.
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After completing the training, I will complete my mediator apprenticeship, which consists of at least 2 observations and 2 co-mediations.
*
Volunteer Commitment Statement
This training costs the Centers $
5
0
0
per student. Each participant will
be required
to pay $
100
to help cover the cost of food. Light breakfast and a full lunch will be provided in addition to snacks on training days. If the fee is a burden there are scholarships available.
Volunteers are expected to make a commitment of a minimum of
40 hours
per year
in each of the following two years.
Volunteer hours may be obtained through mediating,
attending monthly training sessions,
assisting
with events, and other jobs that may be needed by the Community Mediation Center. Except under
special circumstances
to be
determined
by the Center’s Director,
any participant who does not honor this commitment will be invoiced for the balance of the training fee ($5
0
0
), payable to the
Center.
I HAVE READ AND UNDERSTAND THE CONTENTS OF TH
E ENTIRE MEDIATOR TRAINING APPLICATION TERMS AND AGREE THAT SHOULD I NOT FULFILL MY VOLUNTEER COMMITMENT TO A MINIMUM OF 40 HOUR PER YEAR FOR THE TWO YEARS FOLLOWING TRAINING, I WILL BE INVOICED FOR THE BALANCE OF THE TRAINING FEE. FURTHERMORE, I CONFIRM THAT ALL INFORMATION PROVIDED IS TRUTHFUL AND ACCURATE.
Signature:
*
Please type in your full name which will serve as your signature.
Date:
*
Thank you for your interest.
Basic Mediation Training dates
April 4th
6:00 pm – 9:00 pm
April 5th
9:00 am – 12:00 pm
Lunch Break 12-1:15
1:15 pm – 6:00 pm
April 6th
9:00 am – 12:00 pm
Lunch Break 12-1:15
1:15 pm – 5:00 pm
April 11
th
6:00 pm – 9:00 pm
April 12t
h
9:00 am – 12:00 pm
Lunch Break 12-1:15
1:15 pm – 6:00 pm
April 13th
9:00 am - 12:00 pm
Lunch Break 12-1:15
1:15 pm - 5:00 pm
Submit
Home
About Us
Our Services
Conflict Mangement Workshop
Conflict Coaching
Facilitation / Organizational Development
Family Mediation
IEP / Attendance Mediation
Neighborhood Mediation
What to Expect
Community Conversations
Join Us
Volunteer
>
Volunteer Application
Board Member Application
Mediator Application
Careers
LFT 5k & Dance-a-Thon
2025 LFT 5k
LFT 2024 Race Results
Race Results 2023
LFT 2023 Pictures
Community Events
Donate
Mediators Login
Contact Us
Make A Referral