Mediator Forms

adobestock_72391719-e1452284519990

 

Apprenticeship Applications

Application for Apprenticeship – General District Court (Civil)
Form to be submitted in order to begin observations and co-mediations.

Application for Apprenticeship – Juvenile and Domestic Relations and/or Circuit Court Family (Family)
Form to be turned in completed to Diana Ortiz at clientservices@nvms.us in order to begin family co-mediations.

Virginia State Mediator Certification Forms

Verification of Observation Form (ADR 1007)
Form to be completed by mentor and mentee when fulfilling the observation requirement for state certification.

Guided Mediation Observation Worksheet

Mentee Portfolio Form (ADR 1008)
Form to be completed by mentor and mentee before a co-mediation and during post co-mediation debrief.

Mentee Evaluation Form (ADR 1001)
Form to be completed by mentor after co-mediation took place. Mentors have 10 days to return the completed form to the mentee.

Application for Mediator Certification
Once all the requirements for certification are completed, please complete this application and return it to Richmond.

Application for Mediator Recertification
Every 2 years, certified Virginia state mediators must apply for re-certification.

General District Court and Circuit Court Civil Re-certification Attachments
Attachment to be filed with the Application for Mediator Re-certification.

Juvenile and Domestic Relations and Circuit Court Family Re-certification Attachments
Attachment to be filed with the Application for Mediator Re-certification.

Application for Mentor Status

Mentorship Guidelines for the Certification of Court Referred Mediators

Court Instructions for Mentees

Fairfax Small Claims Court

Arlington Small Claims Court

Loudon Small Claims Court

NVMS Agreement to Mediate – General District Court (Small Claims)