APPLICATION FOR MEDIATION COURSE CERTIFICATION 2026

1. Click ‘Get Form’ to open the APPLICATION FOR MEDIATION COURSE CERTIFICATION in the editor.
2. Begin with SECTION I: TRAINER INFORMATION. Fill in the trainer's name, address, telephone, email, and fax. Indicate if the trainer is a Certified Virginia Mediator and provide the certification number if applicable.
3. Continue by answering whether the trainer is currently a Certified Trainer through our office. If not, attach a resume detailing experience as a trainer of adult audiences.
4. In SECTION II: COURSE INFORMATION, enter the title of the proposed course and its length. Specify the type and number of CME hours requested.
5. If your course is less than two hours, check the appropriate box and attach a course outline. For courses two hours or more, check that box and attach detailed materials including agendas and evaluation forms.
6. Move to SECTION III: BACKGROUND. Answer questions regarding any felony or misdemeanor convictions and professional disciplinary actions. Provide details if applicable.
7. Finally, complete SECTION IV: CERTIFICATION by signing and dating the form to certify that all information is accurate before submitting it to Dispute Resolution Services.

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