::Get involved with CMC::

"We don't see things as they are, we see them as we are." ~Anais Nin

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Application for
CMC's General Sessions Court
Volunteer Mediation Training
click here for last year's schedule and directions

1. Please provide the following contact information:

First Name

Last Name

Title

Organization

Street Address

Address (cont.)

City

State/Province

Zip/Postal Code

Country

Work Phone

Home Phone

FAX

E-mail

URL

Date of Birth

Gender Male Female

2. Select any of the following options that apply:

Rule 31 Civil Mediator
Rule 31 Family Mediator
Mediator listed in a state other than TN
Attorney licensed in TN
Attorney licensed in another state/country
Attorney with inactive license in TN
Attorney with inactive license in another state/country

3. If you are a mediator and/or attorney in another state/country, please provide state where you are/were licensed.

4. If you are a Tennessee attorney, please enter your BPR number:

5. Where and from whom did you receive your mediation training?

6. When did you receive your training?

7. Have you ever volunteered to provide pro bono mediation or legal services?

yes
no

If yes, for what organization did you volunteer?

8. Select any of the following options that apply:

I am available to mediate on Monday morning, 8:30-12.
I am available to mediate on Tuesday morning, 8:30-12.
I am available to mediate on Wednesday morning, 8:30-12.
I am available occasionally for afternoon or evening mediations.
I am not available to mediate on a regular (weekly) basis, but can do so occasionally.

9. Anything else you'd like to tell us about yourself:

Copyright � 2007 CMC. All rights reserved.
Revised: 02/24/12

community mediation center :: 912 South Gay Street :: Suite L300 :: Knoxville, TN 37902 :: P865.594.1879 :: F865.594.1890 :: info@2mediate.org

Copyright � 2007 CMC. All rights reserved. Revised: 02/24/12

Copyright � 2007 CMC. All rights reserved.
Revised: 02/24/12