BMT Application
Basic Mediation Training
January 8-9 & 15-16, 2021
Via Zoom
Fee: $150
Once you've completed the form below please submit payment. Spots are not
reserved until payment is received. Checks made payable to West Hawai‘i Mediation
Center and mail to address below or call to arrange a credit card payment.
P.O. Box 7020 Kamuela, HI 96743
808-885-5525
info@whmediation.org

I understand that this application is for one 24-hour basic mediation training and that selection of apprentices will be based on a careful screening process and is not guaranteed. While we hope trainees will be interested in being considered for our apprenticeship program, you are welcome to take this training even if you do not plan to become a volunteer mediator.
Full Name *
Birthdate *
MM
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DD
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YYYY
Phone Number *
Mailing Address *
Email *
Highest level of schooling completed *
Languages spoken *
Why are you interested in mediation training? *
What types of conflicts are you most interested in learning how to facilitate? *
Required
Are you interested in becoming a volunteer mediator if you are selected for our apprenticeship program? Why or why not? *
How did you hear about our training? *
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