Apply Community Mediator Community Mediation Class Application Please complete the following application to attend the Mediation Center's Community Mediation Class. Our team will contact you to confirm receipt and answer any questions that you may have. Name(Required) First Last Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Which neighborhood/community do you live? Phone(Required)Email(Required) Confirm Email(Required) I want to attend the training for the following session(Required)Spring Training: March 31st, April 1st, 7th, and 8th, 2023Fall Training: August 18th, 19th, 25th, and 26th, 2023Virtual, September 14-17, 2022In-person, September 14-17, 2022The Mediation Center receives funding to provide the Restorative Conferencing Training for free. As part of reporting requirements, please complete the following section.Gender(Required)Please Choose An OptionFemaleMaleTransgenderPrefer not to discloseAge(Required)Please choose an option14 or under15 - 19 years20 - 34 years35 - 64 years65 - 84 years85 +Household Income(Required)Please Choose an Option$0 - $9,999$10,000 - $24,999$25,000 - $49,999$50,000 - $74,999$75,000 +Race(Required)Please Choose an OptionAfrican descentAsian/South Pacific descentCaucasian/European descentHispanic/Latino descentIndigenous descentMulti-racialRace Not Identified AboveUnknownEmployer(Required) If unemployed, please identify as "Unemployed," and if self-employed, please identify as "Self-employed" in the field box.Help our team know more about your interest in Community Mediation.Why are you interested in this community mediator training program?When you think of the skills needed to deescalate community level conflict, which of those skills have you developed prior to now? How did you develop them?What role would you like to play in helping your peers here in Savannah (and other parts of Georgia) develop community mediation skills?What types of community conflict in your neighborhood (or in the County) most concern you?If there is someone else that you recommend we contact, please list their name and contact information below.What local organizations, associations, or groups do you currently support?Commitment to Volunteer as a Community Mediator I agree I do not agree By completing this 28-hour training, I will volunteer time to resolve conflicts in my community. I understand this means I will not charge participants a fee for the community mediation and facilitation I provide. In order to be added to the volunteer mediator roster, I will be responsible to sign and submit a Volunteer Commitment Form. Furthermore, I agree to answer a monthly questionnaire so the Mediation Center can report the impact and value of my work, conflict resolution programs, and the needs of the community.By agreeing to commit as a Community Mediator I agree to volunteer and resolve conflict in the following ways Out in the community with little or no support from the Mediation Center Out in the community with the help and support of the Mediation Center Mediating and facilitating at the Mediation Center in a more controlled environment Community conversations/dialog Not sure how I want to volunteer. I just know I want to support my community and the Mediation Center in any way I can. Do you have any questions or comments you'd like us to consider?How did you hear about the class? Δ