Mountain Mediation Center Volunteer Application
MMC welcomes community members regardless of race, color, religion, national origin, family status, immigration status, disability, sexual orientation, or gender.
Full Name
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Phone Number
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Email
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Volunteer Interest
Please list all areas of interest
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Conducting Mediations (Required to be on state court-qualified roster)
Restorative Justice Programming
Community Conversations
Administration & Events
Marketing/Social Media/Website
Other
For Mediators: Are you on the state's court qualified mediation roster?
Yes
No
Are you on the state's domestic court qualified mediation roster?
Yes
No
Relevant Education/Training:
Mediation Experience:
Current Employment Information (for Mediators and General Volunteers)- Name of employer, length of employment and brief job description
I certify that I will commit to at least 10 hours of volunteer work with MMC.
Yes
No
Utah Mediation Best Practice Guide- Mediators Only
Below is a link to the Utah Mediation Best Practice Guide (the “Guide”), which Mountain Mediation Center has adopted in its entirety. https://www.utcourts.gov/mediation/docs/Mediation%20Best%20Practices%20Guide.pdf
Do you confirm that you have read the Guide, are familiar with its contents, and that you will endeavor to comply with the statutes, rules and model standards set forth in the Guide as a volunteer for Mountain Mediation Center.
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Yes
No
Ethical Statement- All Volunteers
Mountain Mediation Center requires its volunteers to uphold the ethical standards for court approved mediators as set forth in Utah Code of Judicial Administration (UCJA) Rule 4-510.03. The standards require you to “be of good moral character in that the provider has not been convicted of a felony, a misdemeanor involving moral turpitude, or any other serious crime, and has not received professional sanctions that, when considered in light of the duties and responsibilities of an ADR provider, is determined by the Director to indicate that the best interests of the public are not served by including the provider on the roster.”
I certify under penalty of perjury that this is a correct reporting of my legal and professional records.
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Yes
No
Please use this additional space for any information or comments you would like MMC to know.
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