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Mediate.com Certification Application

Information on the Mediate.com Certification Program is here.  This is how you get started:

You are wisest to first review the questions and requirements and then to work on your Mediate.com Directory Listing and your professional web site to be sure that all required information has been posted (prior to submitting this Application Form).  

• Log into your Mediate.com account by going to www.Mediate.com/Account,
• enter your user ID and password
• click "OK"  

On your Account/Order page, click the link, "Mediate.com Directory Listing" to complete and adjust your directory information. 

Mediate.com is now providing advance certification approval to:

• IMI Certified Mediators
  
• ACR Advanced Practitioners (Family)
  
• ACR Advanced Practitioners (Workplace)
  
• IAM Fellows
  
• ACCTM Fellows
  

Final approval is accomplished when all of the required information is posted in your directory listing online. 

1) To get the process started, first order "Certification Review" and pay the $149 certification review fee:

2) You will receive an email with additional guidance. 

3) As described in the email, you will want to complete the Application Form below.

Name	first last
Email
Mediate.com Account #:
Are you currently any of the following:	IMI Certified Mediator ACR Advanced Practitioner (Family) ACR Advanced Practitioner (Workplace) IAM Fellow ACCTM Fellow
Describe any other mediation certifications that you have:
Confirm you have listed at least 100 hours of training in your directory record:	yes not yet   (Required)
Confirm you have provided complete required practice information on in your directory record:	college and graduate degrees listed professional background described credentials and affiliations indicated training listed (dates, trainer(s), title) mediation practice and approach described mediation fees and costs stated a recent picture shown   (R)
Confirm that your self-evaluation level is shown:	Senior Practitioner Associate None of the above   (R)
Confirm you have designated your mediation cases by practice areas on my Mediate.com Directory Listing:	yes not yet   (R)
Confirm you have indicated whether you have liability insurance in your directory record:	yes not yet   (R)
Confirm you have displayed your references or have available on request:	yes not yet   (R)
Confirm you agree to the stated Mediator Standards of Practice:	yes no   (R)
Confirm you will verify 12 hours of annual continuing education:	yes no   (R)
Have you ever been convicted of a felony?	yes no   (R)
If yes, please describe:
Have you ever been professionally disciplined?	yes no   (R)
If yes, please describe:
Do you desire any waiver of requirements or equivalency consideration? If so, describe:
Your additional comments:
I verify the accuracy of all my provided information:	yes no   (R)
Verification (to make sure you're human) Enter the text you see in image (or refresh for new text)
Note: Please do not include any URLs in form.

Jim Melamed,
CEO Mediate.com
admin@mediate.com

We will be in touch with you within no more than 30 days with initial action upon your application or a statement of additional needed information. 

If proper action upon your application is unclear, additional information will be requested and/or a certification interview will be scheduled.