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?

Other
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)
Space for comments to expand on the above (optional)
7. What type of organisation are you? Tick all that apply.

Other
8. Roughly how many mediators does your organisation have?
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.Format: 00000 000000.
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.

Rows	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.

Other
17. Which counties in England do you currently cover? Tick all that apply.

Other
18. If you cover London or Greater London, which London boroughs do you serve?

Other
19a. Do you operate in Wales? If yes, which areas?

Other
19b. Do you operate in Scotland? If yes, which areas?

Other
19c. Do you operate in Northern Ireland? If yes, which areas?

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