CJAM Financial Assistance Training Scholarship Application Form

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The Community Justice & Mediation Center (CJAM) is committed to building a diverse and representative volunteer mediator team and to offering affordable mediation training. If you live or work in Monroe County and need financial assistance to enable you to attend the training, please complete this application form. We have a limited amount of funds available. Once your application is reviewed we will contact you. If you have additional questions, please contact us at admin@cjamcenter.org
If you complete this form, you do not have to complete the training application form. Thanks for your interest!

Date: *

First Name *

Last Name *

Email *

Address (Street,City,State,Zip) *

Phone Number *

D.O.B. *

Gender

Race

If applicable: Employer and occupation (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 requesting financial assistance? *

40-Hour Mediation & RJ Training: Winter 2021 (Feb. 4, 6, 11 13, 18, 20, 25, 27, March 4 & 6)

40-Hour Mediation & RJ Training: Fall 2021(September 9, 11,16,18,23,25,30,Oct. 2,7,and 9th)

Required

Reason for attending training: *

We have a limited amount of scholarships available. How much are you able to contribute to the cost of the training? (Cost:$300) *

Any additional comments, including accommodations we should consider :

Submit

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