Application for training scholarship of the Midlands Mediation Center’s Introduction to Mediation CoursePlease enable JavaScript in your browser to complete this form.Name *FirstLastMobile Phone NumberEmail *AddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEducational Attainment *Please provide the name of the college or educational institutes attended for your undergraduate and/or graduate degrees. Indicate degree earned. Ex: Columbia College B.A. Religion If educational attainment is included in your resume, please type (SEE RESUME) (If none, please indicate “NONE”)Community or Volunteer Experience *Please list the organizations and type of support provided to the organization within the last 5 years. (if none, please indicate “NONE”) Ex: Harvest Hope Food Bank – Shelf Stocker – 2017-2020Are there any physical or mental conditions that might affect your ability to perform the duties of a mediator? *YesNoIf yes, what accommodations are needed? If there any physical or mental conditions that might affect your ability to perform the duties of a mediator, please state needed accommodations. If selected, are you willing to submit to a South Carolina Law Enforcement Division (SLED) or other appropriate law enforcement background check? *YesNoFile Upload – Resume and Training Credentials Click or drag files to this area to upload. You can upload up to 5 files. Please provide your resume and copies of any certificates received from mediation training My signature below indicates my commitment for this scholarship opportunity: • To attend and participate in all sessions of the Mediation Training. • To serve as a volunteer co-mediator or mediator for at least 24 mediation sessions in the 12 months following the Mediation training. • To abide by South Carolina’s ADR Rules and Standards of Conduct for Mediators. • To be responsive to the MMC staff’s scheduling requests. • To participate in post-mediation debriefing sessions and continuing education opportunities. • To promote the services of Midlands Mediation Center as appropriate within my practice and recruit potential new volunteer mediators. My signature below also confirms my consent for my name and photograph/videos including me to be used by the MMC for promotional purposes through any medium.SignatureClear SignatureDate *Submit