Mediation Foundation Training Application Form

Foundation Mediation Course

Overview
Thank you for your interest in our upcoming Foundation Mediation course. We look forward to meeting you and working with you on the course.

A comprehensive outline of the course can be found in our training brochure by clicking HERE. Please read the brochure before you continue with your enrolment.
At the end of the course each trainee will complete a written portfolio to demonstrate their learning and understanding of mediation, its processes and the skills required to be an effective Mediator.

The portfolio is based on the content of the course and must be completed within 30 days of the end of the course.
I confirm I have read the Mediation training brochure*

Mediation Foundation Training Course

Participant Registration Form
Title: Ms./Mr./Mrs./Dr./Prof:*
Name:

First Name Last Name
Address*

Street Address

Street Address Line 2

City Country

Post Code
E-mail*
example@example.com
Mobile/Contact Number*
This course requires that you have a good standard of written and spoken English. Educational attainment to Level 2 is a requirement of the course and the subsequent course portfolio.
Please give a brief outline of your current job role and work experience paid or voluntary*
Educational qualifications*
Have you completed any previous training in any related fields Yes / No*

YesNo
If Yes, please provide details
Please state your reasons for wanting to attend the mediation skills course*
Where did you hear about the course?*
Dates of the course:

Feb 23rd, 24th, March 2nd, 3rd and 9th 2023

The course will be delivered remotely with the option of Day 4 in person, depending on the availability of the whole group to meet in person. Where the whole group cannot meet in person, Day 4 will be delivered remotely.

NB: Please make sure that you have the appropriate broadband service in order to attend over the length of the course.
Please indicate below whether you would be willing/able to attend in person on Day 4 in Luton, Bedfordshire?
Venue: The course will be delivered online via Zoom (in the main). Joining instructions will be sent prior to the start date.
The course will proceed if a minimum of six (6) trainees enrol. If for any reason the course does not proceed, all fees will be refunded as per our terms and conditions (see below for more details).
Course Fees:

ONLINE: £875 (with potential of 1 day in person)
Hybrid (3/4 days online/up to 2 days in person): £975
In person: £1075

The fees costs cover all training sessions and training materials; Participants must attend all of the sessions and complete the course portfolio within 30 days of the end of the course to successfully complete the course.

There is a 10% discount for all applicants accepted up to 8 weeks before day one of the course.

We often have trained mediators requesting to join the course as a refresher - we offer a significantly reduced fee for those already trained - please select the appropriate payment details below.

A £100 deposit is required to secure your place*

NB: All course fees must be paid in full by two weeks before the start of the course.
Do you have any learning needs/ or where applicable dietary needs?
If you have selected "Yes" above, please give details of your learning needs?
Payment

If you are self-funding, please indicate how you wish to pay upon submission and acceptance onto the course, below.
I wish to pay:*

In FullVia Payment Schedule (Including deposit)By a SponsorI have previous trained as a mediator (*please contact regarding eligibility for additional discount)
Payment Shedule Terms: (via bank transfer only)

# - Please email us directly at: office@changemakerllp.co.uk.

* - All Applicants can pay up their full course fee at any time up to 3 weeks before the course start date

NB: Dates for the subsequent payments will depend upon the date in which the initial deposit is paid.
I wish to pay by:*

Bank Transfer – (details to be provided upon submission of the completed form).Credit or Debit Card (Payment in Full or Deposits payments only).Invoice - Payment due within 30 days of invoice. (Payment in Full Only).I am being sponsored and payment arrangements have already been made.I am being partially sponsored - I will contact you directly for payment terms.I have previously trained as a mediator - Please contact me directly with details of course fee (discount eligibility) and any payment terms.
If you are not self funding please supply details of the full name and address and name of the person or department to which the invoice for the course fees should be sent:
Note: Each course will have a set period in which anyone accepted onto the course will have the opportunity to get an advertised percentage % discount off the full course fee, for early payers only
* Cancellation of a course booking will be subject to the following charges

More than six weeks before course begin	Full Refund
Over 2 weeks but less than 6 weeks before course begins	75% of fee payable
Two weeks or less before course begins	No Refund

“The Service” reserves the right to alter or cancel courses.

If “The Service” cancels, the course all fees will be refunded.
Signature of applicant:

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Foundation Mediation Course

Mediation Foundation Training Course