Dispute Mediation Service, Inc.
Application for Mediation Training
Date:________________________________
Name: ________________________________________________________________________
Phone: Day/Office _________________________ Night/Home ________________________
Mailing Address _______________________________________________________________
______________________________________________________________________________
City ___________________________________ State________ Zip Code _________________
Date of Birth ____________________________ Ethnic Background _____________________
Other language(s) fluency (Can you conduct a mediation in the language?)
_______________________________________________________________________________
Educational Background
_______________________________________________________________________________
_______________________________________________________________________________
Occupation
_______________________________________________________________________________
Are you available to attend 40 hours of mediation training conducted on weekdays and/or portions of weekends? _______________
DMS mediations are usually scheduled for half day sessions, Monday through Friday, mornings and afternoons, Tuesday and Wednesday evenings, 6-9 pm, and occasionally Saturday mornings.
Will you be available to mediate at DMS as a volunteer? ________________
Please return this application with your resume to:
Dispute Mediation Service, Inc.,
3400 Carlisle #240 LB-9, Dallas, TX 75204-1272
Phone (214) 754-0022 FAX (214) 754-0378
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