1. Applicant Information Name(Required)
First
Last
Home Address(Required)
Work Address
Membership and qualifications in any other related organizations
Brief description of the professional context of your mediation practice(Required)
Family mediation experience(Required)
Number of Family Mediations Completed(Required)
2. Curriculum Vitae Curriculum Vitae(Required) Please upload your resume outlining your education and professional qualifications and achievements.
3. Family Mediation Training Please complete the sections below indicating the hours completed for each. Note the required amount of hours indicated above each.
Section A) Basic Mediation Training
Basic conflict resolution and mediation theory education and skills training including intercultural training. AT LEAST 80 HRS REQUIRED.
Upload Any Training Certificate(s)
Section B) Additional Training
Further related education and training. AT LEAST 100 HRS INCLUDING HRS BELOW.
i. Family Dynamics of separation and divorce. AT LEAST 35 HRS REQUIRED.
ii. Family and child Law. AT LEAST 14 HRS REQUIRED.
iii. Power imbalance and dynamics and effects of abuse. AT LEAST 21 HRS REQUIRED.
iv. Financial Issues including support. AT LEAST 7 HRS REQUIRED.
v. Ethical Issues. AT LEAST 7 HRS REQUIRED.
vi. Drafting Agreements. AT LEAST 7 HRS REQUIRED.
vii. Other Elective Hours
Total Hours (A + B)
4. Proof of Practicum / Mediation Experience Please complete either Section (A) or (B), depending on your mediation experience:
Section A: Experienced Mediator
If you are applying as an experienced mediator, you must meet the following criteria:
i) 2 years experience as a family mediator doing separation and divorce;
ii) have completed a minimum of 10 cases (at least 80 hours) with clients around separation and divorce.
And you must provide:
i) two Memoranda of Understanding or Agreements that you have authored for your clients at the conclusion of mediation around separation and divorce. Please remove all identifying features (names of clients, addresses, birthdates, file numbers) prior to sending the copies of the documents to us.
ii) two letters of reference on the approved reference form (found in Certifications > Certification Documents). These cannot be client references.
Upload Files 2 x Memorandum of Understanding or Agreements, 2 x Letters of Reference
Section B: New Mediator
If you are applying as a new mediator because you do not meet the requirements in part (a), please provide:
i) proof of practicum completed as set out in Section 5.7 of the FMC Standards (please attach your certificate of completion from your practicum placement);
ii) three letters of reference on the approved reference form (found in Certifications > Certification Documents). One may be from your practicum supervisor/mentor.
Upload Files Proof of Practicum, 3 x Letters of Reference
5. If you have completed your training and have practiced for more than one year, please specify the 20 hours of continuing family mediation education you completed last year. If your original basic mediation training is more than five years old, please specify the continuing education completed over the last three years. Continuing Education Details Please note the requirement that at least 14 hours of continuing education in the last three years must be conflict resolution and/or mediation skills training. Indicate dates, trainers, institutions, and duration.
6. Any disciplinary actions taken against you by any professional association(s)? Disciplinary Action (yes/no)(Required) Disciplinary Action Details If yes, please include date, name of professional body, type of disciplinary action and result.
7. Any ethical difficulties or criminal convictions? Ethical Difficulties (yes/no)(Required) Disciplinary Action Details If yes, please explain.
8. Names of people who will complete your reference forms: Download the 'FMC Certification Letter of Reference' from this site at Certifications > Certification Documents. Have your references fill out the pdf and submit to
[email protected] as outlined on the form.
9. Any matters that might affect negatively the general public’s perception of your ability to adhere to the Elder Mediation Code of Professional Conduct? Code of Conduct Conflicts (yes/no)(Required) Code of Conduct Conflicts Details If yes, please explain.
10. Provide proof of liability insurance coverage (by self or employer) FMC has a group insurance policy should you require it, found under Member Services > Insurance.
Proof of Liability Insurance(Required)
11. Mediation Roleplay Video and Exam (Advanced only) When applying for Advanced Certification, you will be contacted to complete the following additional requirements: (i) Completion and submission of a mediation roleplay video, (ii) Self assessment of skills displayed in your mediation roleplay video, (iii) Final written examination
Confidentiality It is understood that all documents provided by the candidate to FMC are for the purposes of certification only and will be deleted by FMC following the completion of the certification process after no longer than one year. It is the responsibility of the candidate to retain copies of any and all of their personal documents.
Accept Confidentiality Statement(Required)
Statutory Declaration I hereby certify that I am a member in good standing of Family Mediation Canada and that I adhere to the standards set out in the FMC Practice, Certification and Training Standards and the FMC Code of Ethics.
I hereby swear or affirm that the information in this application form and its attachments is true and correct.
I give my consent to the Certification Administrator(s) to inquire about any professional disciplinary actions and/or criminal convictions recorded against me.
Accept Statutory Declaration Statement(Required)
Application Next Steps