Become a Mediator

First Name

Last Name

Email Address

Phone Number

City/Town

Physical Address

Reasons why you want to become a mediator. Maximum 2000 characters.

IS NOT AN UNREHABILITATED INSOLVENT.

DOES NOT SUFFER FROM A SEVERE MENTAL ILLNESS OR A SEVERE OR PROFOUND INTELLECTUAL DISABILITY IN TERMS OF THE MENTAL HEALTH ACT 2002.

HAS NOT BEEN CONVICTED OF A CRIME INVOLVING FRAUD; DISHONESTY OR VIOLENCE.

DISASSOCIATES HIM- OR HERSELF FROM CONDUCT THAT IS RACIST, SEXIST OR INCONSISTENT WITH THE BILL OF RIGHTS IN THE CONSTITUTION.

Become A Mediator

YOUR DETAILS

Character References

Please provide two character references.

Character Reference One

Character Reference Two