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Volunteer Application

Please complete this form to apply to be a volunteer mediator with Southeastern Dispute Resolution Services.

Contact Information

Name *

First Name

Last Name

Phone *

Email *

Verify Email *

Address *

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Languages you read and/or write, and your fluency in each *

Tell us a little about yourself. *

What is your education history/background? *

What is your current or former work/occupation? *

Do you have any previous Volunteer experience? Please list all experiences. *

Please upload your resume. (optional)

Have you completed any mediation training? *

General Civil Mediation Certificate

Domestic Relations Mediation Certificate

Other

None

When did you complete your training. Please list type of training with date below. *

Please upload your General Civil Mediation Certificate

Please upload your Domestic Relations Mediation Certificate

Have you completed your observations? *

Yes

Why would you like to become a volunteer mediator? *

When are you generally available during an average week? *

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

No Preference

Describe Availability

In case of emergency, who should we notify? *

First Name

Last Name

Phone

By entering my name below I hereby agree to serve any client who is assigned regardless of race, sex, gender, creed or national origin. *