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Part 146 Training Application Supplement

This form is a supplement to the Part 146 Training Application, which is used to have mediation training courses approved to train mediators who wish to serve on trial court-annexed rosters in New York State’s Unified Court System.

Please use this form to provide information about your experience as a mediator and a trainer.

If the ADR Office approves your course, your information will be posted on the Part 146 Approved Course List on the ADR Office website.

Please complete this form in full. You will be prompted to to upload your resume/bio for the trainer compiled in a single word or pdf document.

Please be prepared -- if asked -- to submit a training manual, a video clip, references, or appear for an interview. A member of the ADR Office may also request to observe the training either in whole or in part.

If you have any questions, please contact us at [email protected].

Questions marked with a * are required

Name of Training

Contact Information

First Name

Last Name

Phone

Email Address

Organization

Website

Please respond to the following questions about your mediation and training experience:

	Enter Number
How many years have you been mediating?	Enter Number

How many mediations have you conducted?	Enter Number

How many mediation training programs have you conducted?	Enter Number

How many years of experience do you have as a mediation trainer?	Enter Number

Describe your experience as a mediator including your approach to mediation.

Describe your experience as a mediation trainer. Please share about your approach to training and methodologies employed.

Please Upload your Resume/CV