CMC Digital Mapping Form

CMC Digital Mapping Form

Help us map community mediation across England, Wales, Scotland, and Northern Ireland
The Civil Mediation Council is creating a map of community mediation providers across England, Wales, Scotland, and Northern Ireland. If your organisation provides community mediation services, we would love for you to take part.

This questionnaire is for organisations only (not individual mediators). The information you share will help us build a central list and interactive map for general public, showing where community mediation is available and what services are offered.

Thank you for helping us highlight the amazing work happening in communities across the UK. Please click here to access definitions used in the questionnaire.
Section A: Contact details (for internal purposes, not visible on the map):
1. Your full name:*

First NameLast Name
2. Your job title or role at the organisation:*
3. Which email address should we use to contact you (if we need to follow up)?*
example@example.com
4. Are your mediators volunteers, paid, or both?*

All volunteersAll paidA mix of bothOther
Section B: About your organisation

The information you provide will be included in the digital map listed on the Civil Mediation Council website.
5. What is the name of your organisation?*
6. Please confirm if your organisation has the following in place (tick all that apply)*

All mediators have appropriate trainingWritten Code of ConductPublished complaints procedureOngoing CPD and supervision/mentoring for mediatorsProfessional Indemnity insurance cover (no less than £1 million)Public liability and Employer liability insurance coverSuitable and sufficient service administrationRegistered with the Information Commissioner's Office (ICO)Safeguarding policyDBS checks for mediatorsRisk assessments carried out for individual cases
Space for comments to expand on the above (optional)
7. What type of organisation are you? Tick all that apply.*

Company limited by guaranteeRegistered charityCharitable Incorporated Organisation (CIO or SCIO)Community Interest Company (CIC)Social enterpriseStatutory bodyLimited Liability Partnership (LLP)Other
8. Roughly how many mediators does your organisation have?*

01-56-1920-3940-7475+
9. Main office address:*

Street Address

Street Address Line 2

CityState / Province

Postcode
10. Please provide a short description of your organisation (100 words max)*

0/100
11. Please upload your organisation’s logo for use on the digital map of community service providers.*

Accepted formats: PNG, JPG, SVG (max file size 5MB)
Cancelof
12. Please provide your organisation's phone number*
Please enter a valid phone number.
13. Please provide your organisation's website*
Section C: Services offered

14. Which of the following services does your organisation currently provide? Tick all that apply. Please indicate their geographical location.*

	Not offered	Local only	Multiple areas
Neighbourhood mediation
Intergenerational mediation (young people under 18)
Intergenerational mediation (adults)
Co-parenting mediation
Faith-based mediation
School mediation
Bespoke mediation
Group mediation / facilitation
Conflict coaching / one-to-one support
Peer mediation training
Training for community mediators
Conflict prevention training

15. Do you offer any other services not listed above? If so, please list them below (optional):
Space for comments to expand on the above (optional)
16. How do you deliver your services? Tick all that apply.

OnlineFace-to-facePhoneOther
17. Which counties in England do you currently cover? Tick all that apply.*

NoneAll countiesBedfordshireBerkshireBristolBuckinghamshireCambridgeshireCheshireCity of LondonCornwallCumbriaDerbyshireDevonDorsetDurhamEast Riding of YorkshireEast SussexEssexGloucestershireGreater LondonGreater ManchesterHampshireHerefordshireHertfordshireIsle of WightKentLancashireLeicestershireLincolnshireMerseysideNorfolkNorth YorkshireNorthamptonshireNorthumberlandNottinghamshireOxfordshireRutlandShropshireSomersetSouth YorkshireStaffordshireSuffolkSurreyTyne and WearWarwickshireWest MidlandsWest SussexWest YorkshireWiltshireWorcestershireOther
18. If you cover London or Greater London, which London boroughs do you serve?*

NoneAll boroughsBarking and DagenhamBarnetBexleyBrentBromleyCamdenCroydonEalingEnfieldGreenwichHackneyHammersmith and FulhamHaringeyHarrowHaveringHillingdonHounslowIslingtonKensington and ChelseaKingston upon ThamesLambethLewishamMertonNewhamRedbridgeRichmond upon ThamesSouthwarkSuttonTower HamletsWaltham ForestWandsworthWestminsterOther
19a. Do you operate in Wales? If yes, which areas?*

NoneAll areasBlaenau GwentBridgendCaerphillyCardiffCarmarthenshireCeredigionConwyDenbighshireFlintshireGwyneddIsle of AngleseyMerthyr TydfilMonmouthshireNeath Port TalbotNewportPembrokeshirePowysRhondda Cynon TafSwanseaTorfaenVale of GlamorganWrexhamOther
19b. Do you operate in Scotland? If yes, which areas?*

NoneAll areasAberdeen CityAberdeenshireAngusArgyll and ButeClackmannanshireDumfries and GallowayDundeeEast AyrshireEast DunbartonshireEast LothianEast RenfrewshireEdinburghFalkirkFifeGlasgowHighlandInverclydeMidlothianMorayNorth AyrshireNorth LanarkshireOrkneyPerth and KinrossRenfrewshireScottish BordersShetland IslesSouth AyrshireSouth LanarkshireStirlingshireWest DunbartonshireWest LothianWestern IslesOther
19c. Do you operate in Northern Ireland? If yes, which areas?*

NoneAll areasAntrimArmaghDownFermanaghLondonderry (Derry)TyroneOther
20. Would you like to be listed in a public directory of community mediation providers? (We will not share your personal contact details)*

Yes, happy to be listed and consent to the information in Sections B and C being usedNo, please keep our information private
By submitting this form, you confirm that all information you provided in this form is correct and will notify us by emailing comms@civilmediation.org of any changes, to enable your information to be updated.
Should be Empty:

CMC Digital Mapping Form

Section A: Contact details (for internal purposes, not visible on the map):

Section B: About your organisation

Section C: Services offered