Internship Application

Internship

Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Telephone
Cell Phone
Email
How would you prefer to be contacted?
- Phone
- Email
What form of internship are you seeking?
- 50%
- Full
MEDIATION TRAINING
Please provide details of your mediation training:
1. Family Relations
Date Provider Hours
2. Screening
Date Provider Hours
3. Family Law
Date Provider Hours
4. Basic Mediation Skills (40-Hours)
Date Provider Hours
5. Advanced Mediation (21 Hours)
Date Provider Hours
6. (optional) Family Mediation Practicum
Date Provider Hours
7. Other
Description Date Provider Hours
EDUCATION
Please list the post-secondary education you have completed
(i.e. Undergraduate, Gradate, Law SChool, etc.)
School Degree / Certification Year Completed
I consent to Riverdale Mediation requesting confirmation of my degree from the above educational institutions and will sign any documents necessary if requested.
Yes, I consent
PROFESSIONAL OR VOLUNTEER EXPERIENCE
Please list the work/volunteer experience you have obtained that you believe will benefit you in the role of an intern at Riverdale Mediation.
School Position Business Name Duties and Responsibilities Reference Name and Contact
MEDIATION, NEGOTIATION OR OTHER TRAINING
Please list all relevant training you have obtained to date (other than required courses list above)
Date Name of Course Length of Course School / Organization
PROFESSIONAL ORGANIZATIONS
Please indicate which professional organization(s) you belong to:
ADRIO
AFCC
APFM
FDRIO
FMC
OAFM
OCLF
Other
If you had specified "Other"above, please identify which professional organization you had joined:
Please write a short response as to why you would like to become an intern at Riverdale Mediation. Please include your goals and expectations as well as what you would like to accomplish while interning at Riverdale Mediation.
What aspects of the internship program particularly interest you? For example, would you like to assist with research, focus on building certain skills, become involved in professional organizations, etc.?
Upload current CV (pdf)
Accepted file types: pdf.

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School	Degree / Certification	Year Completed

School	Position	Business Name	Duties and Responsibilities	Reference Name and Contact

Date	Name of Course	Length of Course	School / Organization