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 December 31; $275 by January 22, 2021). You may pay through our website,
cjamcenter.org
or
Mail a check to CJAM, 205 S. Walnut, Suite 16, Bloomington, IN 47404
* Required
First Name
*
Your answer
Last Name
*
Your answer
Email
*
Your answer
Address (Street,City,State,Zip)
*
Your answer
Phone Number
*
Your answer
D.O.B.
*
Your answer
Gender
Your answer
Race
Your answer
If Applicable: Occupation & Employer (if student, please list school/major and indicate anticipated graduation date.)
Your answer
How did you hear about this training?
*
Your answer
How long do you plan to be in the Bloomington area?
*
Your answer
Have you had previous conflict resolution training
*
Yes
No
Required
If yes, please describe previous mediation.conflict resolution training.
Your answer
For which training are you applying?
*
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(dates TBD)
Required
Reason for attending training:
*
Your answer
How will this training help you meet your personal/professional goals?
*
Your answer
Are you interested in possibly volunteering with CJAM, once you complete the training? In addition to mediating, we have other opportunites.
*
Yes
No
Possibly
Required
If yes, please indicate what kinds of work you might like to contribute: Mediation, Professional, Office, Marketing, Fundraising, and other skills.
Your answer
Any additional comments:
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Community Justice & Mediation Center.
Report Abuse
Forms
