CJAM 40-hr Mediation & Restorative Justice Training Application Form

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Thank you for applying to attend our 40-hour virtual training. Once your application is reviewed, we will contact you with additional details. If you have questions, please contact us at admin@cjamcenter.org or call 812-336-8677.

The cost of the training is $300. ($275 if registered by August 26, 2022). Once you have been accepted, you may pay through our website, www.cjamcenter.org or
Mail a check to CJAM, 205 S. Walnut, Suite 16, Bloomington, IN 47404

Date *

First Name *

Last Name *

Email *

Address (Street,City,State,Zip) *

Phone Number *

D.O.B. *

Gender

Race

If Applicable: Occupation & Employer (if student, please list school/major and indicate anticipated graduation date.)

How did you hear about this training? *

How long do you plan to be in the Bloomington area? *

Have you had previous conflict resolution training *

Yes

Required

If yes, please describe previous mediation.conflict resolution training.

For which training are you applying? *

40-Hour Mediation & RJ Training: Fall 2022 (Sept 8,10,15,17,22,24,29, Oct. 1, 6 & 8)

40-Hour Mediation & RJ Training: Spring 2023 (TBD))

Required

Reason for attending training: *

Any additional comments, including any accommodation needs we should :

Submit

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