Mentorship Application

If you wish to join the Dignified Dispute Resolution™ Young Mediators’ Mentorship Program you are required to read our Ethical Guidelines and confirm that you agree to be bound by these. Any violation of these guidelines will result in your immediate removal from the program. Upon receipt of your application, and after we have conducted our due diligence investigations, we will make contact with you by email and you will be required to complete a Mentorship Program and Confidentiality Agreement.

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01. Your Contact Info

Name

Surname

Phone number

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02. Your Practice infromation

Name of your practice

Website

Instragram

Facebook

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03. About Youself

Please tell us a little about yourself and why you would like to join the Program

What is your Gender?

What is your Age?

What is your Ethnicity?

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04. Your Mediation info

What is your level of education?

When did you do your Mediation training?

Where did you receive your mediation training?

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05. Your documents

Identity document

Certificates / diplomas / degrees

Mediation training certificate

Curriculum vitae

Agree to Ethical Guidelines

I confirm that I have read and agree to be bound by the DIGNIFIED DISPUTE RESOLUTION Ethical Guidelines.

Declaration

(a) I am not an unrehabilitated insolvent; (b) I do not suffer from a mental illness or a severe or profound intellectual disability in terms of the Mental Health Act (Act 17 of 2002); (c) I have not been convicted of a crime involving fraud or dishonesty or violence, and/or have not been convicted of a crime where the sentence was imprisonment without the option of a fine

Consent to submit this information

Yes, I consent to sharing this information with Dignified Dispute Resolution.
We will make use of this information to contact you. All information you provide is protected by our privacy policy.

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