Mediate.com Certified Mediator graphicMediate.com Certification Application Form

Information on the Mediate.com Certification Program is here.

Certification Application:

Name
first last
Email
Mediate.com Member #:
Confirm you have listed at least 100 hours of training in your directory record:
 yes
 no
  (Required)
Confirm you have provided complete information in your directory record:
 college & graduate degrees
 professional background
 credentials and affiliations
 trainings listed
 mediation practice & approach
 mediation fees
 recent picture
  (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
 no
  (R)
Confirm you have indicated whether you have liability insurance in your directory record:
 yes
 no
  (R)
Confirm you have displayed your references or have available on request:
 yes
 no
  (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:
Your additional comments:
I verify the accuracy of all my provided information:
 yes
 no
  (R)
Verification (to make sure you're human)

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Note: Please do not include any URLs in form.


We will be in touch with you within no more than 10 days with a decision upon your application or a statement of additional needed information. 

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