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ADR DIRECTORATE

APPLICATION FOR ACCREDITATION RENEWAL UNDER THE NATIONAL MEDIATOR ACCREDITATION SYSTEM (NMAS)

Use this form only if you:

o Already have NMAS accreditation and you need to apply for accreditation renewal.

o Are a Community Justice Centres (CJC) mediator or a mediator in a court or tribunal of the Department of Justice (DJ).

Please submit your application six weeks before the expiry date of your current NMAS accreditation.

Every mediator is responsible for managing their NMAS accreditation. This includes keeping track of the expiry date of their accreditation, as well as maintaining records of mediation and continuous professional development (CPD) activities.

All section references in this form are to the Approval Standards, unless otherwise stated.

Name (at it will appear on your certificate): _________________________________

Address: _____________________________________________________________

_____________________________________________________________________

Phone: _____________________ Mobile: _____________________________

Email: ________________________________________________________________

Date current NMAS accreditation expires/expired: ___________________________

Have you:

o Signed the Declaration of Good Character and Ongoing Compliance – page 3.

o Provided evidence of 25 hours of practice experience – pages 4-5.

o Provided evidence of 25 hours of CPD in the past two years – pages 6-10.

o Paid your Mediation Standards Board (MSB) registration fee – page 14.

If you conduct mediations outside of CJC, have you:

o Provided evidence of professional affiliation – page 11.

o Provided evidence of professional indemnity insurance or statutory indemnity – page 11.

DECLARATION OF GOOD CHARACTER AND ONGOING COMPLIANCE

Please read the following carefully and only sign if you can declare that every part of the statement is true. These are required under the Approval Standards and by the ADR Directorate.

Good characterI confirm I am of good character and possess appropriate personal qualities and experience to conduct a mediation process independently, competently and professionally – section 2.1.

Duty to disclose I note my duty to disclose the following:

Disqualification from any type of professional practice – section 2.1(b).

Any criminal conviction – section 2.1(c).

Any impairment that could influence my capacity to discharge my obligations as a mediator in a competent, honest and professional manner – section 2.1(d).

Any refusal of NMAS accreditation or accreditation renewal or suspension or cancellation of accreditation – section 2.1(e).

I declare:

o I have nothing listed above to disclose.

o I am making a disclosure and have attached details to this application.

Ongoing compliance I have read Parts II and III (Approval and Practice Standards) of the NMAS.

I undertake to comply with the Approval and Practice Standards, any relevant legislation, professional standards and any other requirements nominated by the ADR Directorate – section 2.1(f).

I understand the ADR Directorate may conduct an audit to verify my mediation experience and CPD hours over the past two years is correct, or that it may request further details or evidence at any time.

Disclosure of information I acknowledge that the ADR Directorate, as a Recognised Mediation Accreditation Body

(RMAB), can disclose information about me to the MSB and the MSB can release it to other RMABs upon request – section 2.1(i).

Keep my details up to date I agree I will notify the ADR Directorate in writing of any changes to my circumstances

that may reasonably affect my accreditation in this accreditation period.

I agree to provide the ADR Directorate with new contact details (postal address, telephone and fax numbers, email address) within 14 days should any of these change.

Declaration I declare the content of this application is true and correct to the best of my knowledge.

SIGNATURE: DATE: /__ /

PRACTICE EXPERIENCE

Have you completed at least 25 hours of mediation, co-mediation or conciliation in the past two years? (Section 3.2.)

Yes – provide details of at least 25 hours’ experience in table 1, then go to page 6.

No – provide details of all practice hours completed in table 1, then go to page 5.

Table 1: practice experience

Was it solo mediation or co-mediation or conciliation? Date Location Hours

TOTAL HOURS: _________

PRACTICE EXPERIENCE (between 25 to 10 hours)

Complete this page only if you have completed between 10 and 25 hours of mediation, co-mediation or conciliation in the past two years. Otherwise, go to page 5.

If you have done fewer than 10 hours or the reason you have done between 10 and 25 hours is not listed, please contact us.

I confirm I have completed at least 10 hours of mediation, co-mediation or conciliation in the past two years – section 3.3.

The reasons I have conducted at least 10 hours but fewer than 25 hours are (tick all boxes that apply):

Lack of work opportunities.

Health circumstances.

Career circumstances (eg working in a related area).

I reside in a non-urban and/or culturally and linguistically diverse (CALD) communities.

[Note 1] If you are seeking accreditation renewal with fewer than 25 but more than 10 hours mediation practice in the past two years, the ADR Directorate will contact you to discuss supplementary training, coaching and/or assessment to address the shortfall (section 3.3).

I have previously sought renewal of my NMAS accreditation having completed less than 25 hours of mediation

Please provide dates of previous renewals where this applied.

[Note 2] Mediators can only apply for renewal of their accreditation under section 3.3 for a maximum of three consecutive renewal cycles ( section 3.4).

CONTINUOUS PROFESSIONAL DEVELOPMENT (CPD)

Please refer to section 3.5 when completing this part of your application.

[Note 3] CPD hours for one accreditation period cannot be used for subsequent renewal – section 3.4.

Have you completed 25 hours of CPD activities in the past two years?

Yes – provide details in tables 2 to 7, then go to page 10.

No – provide details of all CPD completed in tables 2 to 7, then go to page 9.

(a) PARTICIPATING IN EDUCATIONSection 3.5(a) – up to 20 hours for training seminars and workshops, or up to 15 hours for attending conferences.

Table 2: CPD participating in education

Name, subject of course/seminar/workshop etc Date Provider Hours

Total (a) hours: ______

(b) REFLECTING ON PRACTICESection 3.5(b) – up to 15 hours.

Table 3: CPD reflecting on practice

Details of supervisor, coach or structure of reflection session Date Hours

Total (b) hours: __________

(c) PROVIDING PROFESSIONAL DEVELOPMENTSection 3.5(c) – up to 15 hours.

Table 4: CPD providing professional development

Name, subject of presentation Date Occasion/audienceHours

includingpreparation

Total (c) hours: __________

(d) CREDIT FOR RELATED PROFESSIONAL CPDSection 3.5(d) – up to 10 hours.

Table 5: CPD credit for related professional CPD

Name, subject of course/seminar/workshop Date Related profession Hours

Total (d) hours: _________

(e) LEARNING FROM PRACTICESection 3.5(e) – up to eight hours (maximum two hours per mediation or simulation).

Table 6: CPD learning from practice

Details Date Hours

Total (e) hours: ________

(f) SELF-DIRECTED LEARNINGSection 3.5(f) – up to 5 hours.

Table 7: CPD self-directed learning

Citation of book, article, podcast or other details

Publisher/URL Date Hours

Total (f) hours: ________

(g) OTHERSection 3.5(g) – up to 5 hours.

[Note 3] Applying for CPD under this category requires the ADR Directorate to seek approval from the MSB. Please allow additional time for this approval to be sought.

Table 8: CPD other

Details Date Hours

Total (g) hours: ________

GRAND TOTAL ALL CPD HOURS: _______

CPD (fewer than 25 hours)

Complete this page only if you have not completed 25 hours of CPD activities in the past two years. Otherwise, go to page 10.

If you have done fewer than 25 hours of CPD and the reasons for this are not listed on this page, please contact us.

I confirm I have not completed 25 hours of CPD – section 3.6.

The reason I was unable to complete 25 hours of CPD activities was because (tick all that apply):

Health reasons.

Career circumstances.

Residence in non-urban or CALD community.

[Note 4] If you are seeking accreditation renewal with fewer than 25 hours of CPD completed in the past two years, the ADR Directorate will contact you to discuss what supplementary CPD you must undertake before your accreditation can be renewed (refer to section 3.6).

[Note 5] Section 3.8 states that all requirements for renewal of accreditation must be met within two months of the renewal date or accreditation will automatically lapse.

MEDIATIONS OUTSIDE CJC

Complete this section only if you do or intend to conduct mediation (other than Family Dispute Resolution [FDR]) outside CJC. Otherwise, go to page 12.

I currently practice or intend to practice mediation outside CJC.

Section 2.1(h) of the Approval Standards requires mediators to become and remain a member of an RMAB or member or employee of an organisation with a relevant ethical code or standard and a complaints and disciplinary procedure that can address complaints about mediators.

Section 2.1(j) of the Approval Standards requires mediators to be covered by relevant professional indemnity insurance or have statutory immunity.

The ADR Directorate only covers these requirements in respect of the work CJC mediators do with CJC. Mediators working outside CJC therefore need to provide additional information. Note however that you do not have to include work as a Family Dispute Resolution Practitioner (FDRP) as this is conducted under your FDRP registration and not NMAS accreditation.

To help you understand what information you need to provide, see the sample responses in Table 9 and the notes on page 11.

Please read these carefully and then fill in table 10 on page 12 for each type of mediation service you provide outside CJC.

Please also attach all relevant evidence.

Table 9: sample responses for mediations outside CJC

Name of mediation

service[Note 6]

RMAB or other organisation with required standards and procedures

– attach evidence[Note 7]

Indemnity insurance or statutory immunity


Anglicare Anglicare Insured as employee of Anglicare (copy of payslip attached)Contact: Jane Bloggs, Manager Mediation ServicesPh: #### ####Email: [email protected]

Private mediation practice

LEADR and IAMA membership(evidence of membership attached)

AONPolicy number #####Expiry ###

Name of mediation

service[Note 6]





(copy attached)

[Note 5] For mediation work outside CJC (excluding FRD mediations), please list the capacity in which you conduct mediations/name of mediation service.

[Note 6] This is the organisation that would handle a complaint about your work mediating outside CJC and must be an organisation that has a relevant ethical code or standard and a complaints and disciplinary procedure. Mediators practising privately will often join a professional organisation in order to access these standards and procedures.

[Note 5] This may include private insurance for private mediators, coverage by an employer through their insurance or statutory indemnity. For private professional indemnity insurance please provide the name of the insurance company, policy number, expiry date and copy of the certificate. For coverage through an employer, please provide the name of the employer, contact person and phone number and evidence of employment status (letter or payslip). For statutory indemnity provide name of Act, section number and any relevant information, including evidence of your employee status if that is relevant to the indemnity.

Complete table 10 for each type of mediation service you provide outside CJC.

Table 10: mediation outside CJC

Name of mediation

service[Note 5]





Name of mediation

service[Note 5]





BLENDED PROCESS (Outside of CJC)

Complete this page only if you do not mediate for CJC and if your mediation practice includes blended processes (for example advisory or evaluative mediation or conciliation which involves the provision of advice). Otherwise, go to page 14.

Section 10.2 of the Practice Standards states that where a mediator uses a blended process such as advisory or evaluative mediation or conciliation, which involves the provision of advice, the mediator must:

a) Obtain consent from participants to use the blended process;

b) Ensure that within the professional area in which advice is to be given, they:

i. Have current knowledge and experience;

ii. Hold professional registration, membership, statutory employment or their equivalent, and

iii. Are covered by current professional indemnity insurance or have statutory immunity

and

c) Ensure that the advice is provided in a manner that maintains and respects the principle of self-determination.

I acknowledge I have read and comply with section 10.2 of the Practice Standards and agree to provide evidence that I comply if requested by the ADR Directorate.

SIGNATURE: DATE: /__ /

MSB REGISTRATION FEE

The MSB registration fee is $100. You are required to pay this fee (section 2.1(g)).

To find out more about the MSB registration fee, go to www.msb.org.au/accredited-mediators

Payment optionsPlease tick how your payment was made:

o Cheque or money order.

o Electronic Funds Transfer (EFT) or Direct Deposit.

Information for making your paymentCheque or money orderCheques and money orders are made payable to “NSW Department of Attorney General and Justice”.

EFT or Direct DepositAccount Name: Department of Justice and Attorney General's Operating AccountABN: 11 005 693 553Bank Name: WestpacBSB: 032001Account: 201716

To help us identify your payment and ensure our payment records are properly updated, you must:

Include your name and CJC 380. Forward the remittance advice before or at the time EFT or Direct Deposit is made.

AddressesCheques, money orders or EFT or Direct Deposit remittance advices need to be sent to the ADR Directorate by one of the following:

Email: [email protected] Fax: 02 8688 9615Post: Locked Bag 5111

Parramatta NSW 2124

mailto:[email protected]

http://www.msb.org.au/accredited-mediators

http://www.msb.org.au/accredited-mediators

SUBMITTING YOUR APPLICATION

Please submit your application by post or email.

Post: ADR DirectorateLocked Bag 5111PARRAMATTA NSW 2124

Email: [email protected]

QuestionsIf you have any questions, please contact the ADR Directorate:

Telephone: 02 8688 7455Fax: 02 8688 9615Email: [email protected]

Office use only

Page Item Completed

1 Personal details

2 Declaration of Good Character and Ongoing Compliance

3-4 Practice Experience

5-9 Continuing Professional Development

11 Professional affiliations

11 Professional indemnity insurance

12 Blended processes

13 MSB registration fee

Approved by: _____________________________________________________

Signature: Date: / /

Certificate issued by: _______________________________________________

Signature: Date: / /

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