Volunteer Mediator Application

Thanks for you interest in the Early Settlement mediation program. The program is funded by the Supreme Court of Oklahoma and utilizes volunteers who have been trained and certified by the Administrative Director of the Court. The initial basic training is a 20-hour course provided at no charge to volunteer applicants who agree to give 10 hours of volunteer service back to the program each year.

Upon completion of the training you will be scheduled to observe a certified mediator conducting a small claims case or something similar, and then be obeserved mediating a case to be considered for certification.

Additional information about Early Settlement is available at https://adrs.oscn.net/

If you have questions about how to properly complete this form please contact our office at 405-295-6180

Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email (Note: most communication from our office will be via email).

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Occupation (If college student please notate here)

If you are a licensed attorney, please enter your OBA#

How did you learn about Early Settlement Mediation? (Please select all answers that are applicable)

What do you expect to gain from this training/experience?

Have you previously applied for training with any other Early Settlement program?

If Yes, Please list Early Settlement Program Name Below and Date of Application

Rows	Early Settlement Program Name	Date of Application

Have you received any previous mediation or communication training as well as other forms of Alternative Dispute Resolution (ADR) training?

If Yes, Please list the training information below

Rows	Description of Training	Provided by	Number of Hours	Date M/YR
Training 1
Training 2
Training 3

Are you currently, or have you been involved with volunteer activities in the past?

If yes, Please list past and present volunteer activities with which you have been involved with:

Rows	Organization Name	Description of Volunteer Activity	Start Date (M/YR)	End Date (M/YR)
Activity 1
Activity 2
Activity 3

Have you been convicted of a felony within the past 5 years?

If yes, Please explain below:

Do you have a reliable form of transportation?

Do you speak any languages other than English?

If yes, please list additional languages

In this next section we want to learn about your experience.

Please list (3) references who know you and your work from both paid or volunteer work settings and/or educational settings. Do not list relatives as references. In providing us with these references, you accept that our discussion with your references are confidential. This is important to assure complete candor.

Rows	Name:	Email Address	Phone	Relationship
Reference 1
Reference 2
Reference 3

Are you currently a college, or university student?

If Yes, please tell us what college or university you attend and your major/ field of specialization, date of graduation, and do you plan to reside in Oklahoma following graduation?

Rows	Name	Major/Field of specialization	Date of Graduation	Do you plan to reside in OK following graduation?
College/ University

Please mark, or check, each statement acknowledging that you have read it and are in agreement with the statement:

Why do you want to volunteer as an Early Settlement Mediator?

Please indicate what times you would be available to mediate for Early Settlement

Please select the locations you would be able to mediate for Early Settlement:

Signature By signing below you acknowledge that you have read and agree to the above statements and have answered all questions as truthfully as possible.

The signature box is SENSITIVE! Please check that your signature is complete before hitting the submit button.

Date of Signature:

Date

Supreme Court of Oklahoma

Alternative Dispute Resolution System

VOLUNTEER MEDIATOR CANDIDATE AGREEMENT

On this number day of month 20 year , I, First Name, upon having been interviewed by the program director, understand that I have just completed the first, in a series of volunteer qualifying events for the area mediation program. The next step in the series is the satisfactory completion of a 20-hour introductory mediation training program. My satisfactory completion will be based on evaluations by the local program director with input from the training program facilitator, group leader and coach. The evaluation is focused on my understanding of the mediation process as demonstrated through performance. I understand that this training will qualify me to move on to the next phase of certification as a mediator pursuant to the provisions of the Dispute Resolution Act, 12 O.S. Supp. 1991 sections 1801 et seq., and I will be notified by the local program director or coordinator of my additional certification requirements including, at a minimum, observing a mediation conducted by an certified mediator and being observed while conducting a mediation.

Upon attaining certification as a mediator pursuant to the provisions of the Act, I agree to provide a minimum of 10 hours per year of service to the certified programs of the Oklahoma Alternative Dispute Resolution System (ADRS). If I choose not to continue in this process, I will notify the local program director, or coordinator, in writing, of my intent to discontinue participation in the mediation program.

I understand that the Act (i.e. certification, confidentiality, liability, privilege, etc.) is applicable to me only when I am mediating for a certified program of the Oklahoma ADR System and am acting as a volunteer. I will not claim, advertise or assert that I am certified as a mediator except in reference to my volunteering under the authority of a certified program of the Oklahoma ADR System.

I UNDERSTAND THAT I MAY BE RELEASED, AT ANY TIME, FROM DUTIES AND RESPONSBILITIES AS A CANDIDATE AND/OR CERTIFIED MEDIATOR, BY THE LOCAL PROGRAM DIRECTOR OR COORDINATOR, OR THE MEDIATION TRAINER. I UNDERSTAND THAT IF I OBTAIN CERTIFICATION IT WILL EXPIRE ONE (1) YEAR FROMT HE DATE OF CERTIFICATION, UNLESS EXTENDED BY THE ADMINISTRATIVE DIRECTOR OF THE COURTS. IF I LOSE MY CERTIFICATION, I UNDERSTAND THAT ANY REFERENCE I MAKE TO IT MUST LIST THE DATES BETWEEN WHICH IT WAS VALID.

Thank you for completing our Volunteer Mediator Application. Our office will be in touch soon!

Volunteer Mediator Candidate Signature:

The Signature Box is very SENSITIVE! Please check that your signature is complete before hitting the submit button.

Date of Signature

Date