NCRC Application for Community Mediation Training

A 30-40 hr training that has been approved by the TN Supreme Court Rule 31

Contact Information:

Name: ______Date: ______

Address: ______Eve Phone: ______

City: ______Zip: ______Cell Phone: ______

E-Mail:______Day Phone: ______

How did you hear about NCRC? ______

______

NCRC is committed to ensuring diversity in its trainings. Please tell us about your background:

Gender (check one):  Female  Male Age: ______Religion (optional): ______

Race/ethnicity: ______Country of birth: ______

Languages spoken, other than English: ______

Languages written, other than English: ______

Current Employment: ______Current Salary: ______

Former Employment: ______

Highest level of education completed (check one):  High School  College  Graduate School

Dates of study: ______Name of School: ______

Dates of study: ______Name of School: ______

Dates of study: ______Name of School: ______

Subject studied / Degree earned: ______

______

Essay questions (Please submit BRIEF responses):

  1. What interests you about conflict resolution & why do you want to become a mediator?
  1. What skills do you have which you think would make you a good mediator?
  1. NCRC is a community organization. What experience do you have volunteering in the community? How much time did you commit to that work and during what period of time?
  1. What days and times during the week are you available to mediate? (NCRC mediation sessions range from 2-5 hours in length, and are usually scheduled between 9:00 am and 5:00 pm.)
  1. Do you have any special dietary needs? (Snacks are provided during the training.)

Terms of Agreement:If selected, Iagree to attend all sessions scheduled for the NCRC Community Mediation Training(approved by theTennessee Supreme Court as a Rule 31 Civil Mediation Training). I understand that, in order to complete the training, I must complete a Mediation Apprenticeship (including two observations and three co-mediations) during weekday hours when mediations are scheduled. Finally, I agree to perform twelve (12) volunteer mediations in NCRC’s Civil, Community, and/or Victim-Offenderprograms within one year of completing my Mediation Apprenticeship. I understand that civil mediations occur on weekdays between 8:00 am 12:00 noon,victim-offender mediations occur on weekdays between 1:00 pm 4:00 pm, and community mediation times may vary.

Signature:Date:

Training Fee:

Mark the option below that best reflects your interests and needs.

FEE / TRAINING / VOLUNTEER WORK
$300 _____ / BASIC TRAINING:
3030 hours of mediation training covering:
  • Analysis of conflict & conflict response
  • Personal conflict management styles
  • The role(s) of the Community Mediator
  • The 5 steps of the Mediation process
  • Handling bias & power imbalances in mediation
  • Cross-cultural communication / Multicultural competency for today’s mediator
  • Games, videos, simulations & role-play exercises
/ 1)5 apprentice mediation observations and co-mediations following completion of the training
2)12 volunteer mediations for NCRC within 1 year
$500 _____
This fee includes $400 for training + $100 for the TN Supreme Court(per the R31trainer fee) / RULE 31* TRAINING:
Over 40 hours of mediation training covering all the topics above plus:
  • Rule 31 standards & procedures
  • Mediation ethics
  • Mediation challenges: dealing with impasse
  • Negotiation strategies for breaking through impasse
  • Becoming a Rule 31-listed mediator
*This option is for individuals who seek to become listed as a Tennessee Supreme Court Rule 31 mediator – see requirements below / Same as above
Request a Scholarship _____ / A limited number of full and partial scholarships are available for individuals with an annual income of $35,000 or less.
Contact NCRC at 333-8400 to learn more. / Same as above

* To become listed (i.e. state-certified) as a Rule 31 Civil Mediator, you must have a minimum baccalaureate degree and six years of practical work experience, per Sections 17(a) and (b) of TN Supreme Court Rule 31. To view these sections of the Rule and/or read about the policies & procedures of all court-based alternative dispute resolution, go to the Administrative Office of the Courts website: .

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TOTAL AMOUNT DUE

NCRC Community Mediation Training

FALL 2011

Application Timeline:

  • August 5Application Due – pages 1 –4

Submit by Fax (615-296-4336), Email () or regular post: NCRC, 4732 W. Longdale Drive, Nashville, TN 37211

  • August 15-17Interviews (required)
  • August 22Notification of Acceptance
  • August 26Deposit due (50% of training fee)
  • September 7Balance due (Remaining 50%)- Check, cash or money order

Fall 2011 Training Calendar & Interview Sign-Up:

The Fall 2011 Training is limited to 20 participants.

Part 1:Basic mediation training (30 hrs instruction time)– full attendance required

Tuesday, Sept 6 (5:00 - 9:00 PM)

Thursday, Sept 8 (5:00 - 9:00 PM)

Saturday, Sept 10 (9:00 AM – 6:00 PM)

Wednesday,Sept 14 (5:00 – 9:00 PM)

Friday, Sept 16 (5:00 - 8:00 PM)

Sunday, Sept 18 (9:00 AM – 5:00 PM)

Part 2:Additional 10 hrs to meet the Rule 31 requirement – full attendance required

Tuesday, Sept 20 (4:00 – 8:00 PM)

Thursday, Sept 22 (1:00 PM – 6:00 PM)