Introduction To Mediation Training Scholarship

Application for training scholarship of the Midlands Mediation Center’s Introduction to Mediation Course

Name *

First

Last

Mobile Phone Number

Email *

Address

Address Line 1

Address Line 2

City

State

Zip Code

Educational 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 – 2017-2020

Are there any physical or mental conditions that might affect your ability to perform the duties of a mediator? *

If selected, are you willing to submit to a South Carolina Law Enforcement Division (SLED) or other appropriate law enforcement background check? *

File 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.

Signature

Date *