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Community Mediation Service Provider Form

9 mins

To complete this application form you will require the following information:

    1. Personal Details

    2. Contact Details

    3. Area of Practice

    Area of Practice:

    Areas of Practice are grouped in 5 main sectors: Agriculture and Environment; Business – includes Civil and Commercial, Insurance, Professional Negligence, Healthcare and Construction; Community and Restorative Practice; Family including Separating Couples and Elder Mediation and Organisation and Workplace.

    Agriculture:
    Civil and Commercial:
    Community:
    Construction:
    Elder mediation:

    Do not tick Elder if you do not have the required certification.

    Environment:
    Family:
    Healthcare:
    Insurance:
    Organisation/Workplace:
    Professional Negligence:
    Restorative Practice:
    Separating Couples:

    Must upload proof of training for separating couples on next section - Profile details



    4. Profile Details

    Please upload the following (it is optional to upload files, this can be skipped):

    • Profile image.
    • Please supply a copy of your certificate for completing your MII accredited training.
    • Please supply a copy of the last page of your MII Assessor’s Report (must be dated within the past year).
    • If you have difficulty uploading your files you may email them to info@themii.ie to request they be added to your application.

    Allowed file types for upload: doc, docx, pdf, xls, xlsx, jpeg, gif, png

    Max file size: 1.2MB


    Declarations:


    5. Summary


    Terms and Conditions:

    I have read and agree to abide by the MII Code of Ethics and Practice I agree to be bound by the MII Complaints and Disciplinary Procedure I have appropriate insurance in place for my mediation practice


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