CJAM 40-hr Mediation & Restorative Justice Training Application Form
Thank you for applying to attend our 40-hour virtual training. Once your application is reviewed, we will contact you with additional details. If you have questions, please contact us at
admin@cjamcenter.org
or call 812-336-8677.
The cost of the training is $300. (Early Bird: $260 by August 16, 2021; $275 by Sept 3 , 2021). You may pay through our website,
www.cjamcenter.org
or
Mail a check to CJAM, 205 S. Walnut, Suite 16, Bloomington, IN 47404
* Required
Date
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First Name
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Last Name
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Email
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Address (Street,City,State,Zip)
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Phone Number
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D.O.B.
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Gender
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Race
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If Applicable: Occupation & Employer (if student, please list school/major and indicate anticipated graduation date.)
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How did you hear about this training?
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How long do you plan to be in the Bloomington area?
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Have you had previous conflict resolution training
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Yes
No
Required
If yes, please describe previous mediation.conflict resolution training.
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For which training are you applying?
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40-Hour Mediation & RJ Training: Winter 2021 (Feb. 4, 6, 11 13, 18, 20, 25, 27, March 4 & 6)
40-Hour Mediation & RJ Training: Fall 2021 (September 9,11,16,18,23,25,30, Oct. 2, 7 & 9th)
Required
Reason for attending training:
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Any additional comments, including any accommodation needs we should :
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