Mediation InstituteNMAS Accreditation Renewal
Section 1: Personal Details
First Name / Last NameEmployer
Job title
Please provide your preferred contact address and phone numbers.
Postal Address
Telephone / ( )
Mobile
Meaning of Acronyms
CPD: Continuing professional development
MSB: Mediators Standards Board
Mi RMAB: Mediation Institute Recognised Mediator Accreditation Body
NMAS: National MediatorAccreditation System
RMAB: Recognised Mediator Accreditation Body
Checklist
☐I have ticked all correct check boxes in the document
☐I have provided information about my Professional Indemnity Insurance or statutory immunity
☐I have attached two letters of reference or other evidence of good character (2.1 a)
☐I have included payment information or paid online
Section 2: Requirements for NMAS Re-Accreditation
2.1 An applicant must be of good character and possess appropriate personal qualities and experience to conduct a mediation process independently, competently and professionally.
To be approved for NMAS re-accreditation you must:
a)Discloseifyouhavebeendisqualifiedfromanytypeofprofessionalpractice.
□I have not been disqualified from any type of professionalpractice
□Details of the circumstances of my disqualification areattached
b)Disclose if you have any criminalconviction.
□I do not have any criminalconvictions
□Details of the circumstances of my criminal convictions areattached
c)Discloseanyimpairmentthatcouldinfluenceyourcapacitytodischargeyourobligationsina competent,honestandprofessionalmanner
□I believe I have the capacity to mediate in a competent, honest and professionalmanner
□Details of impairmentsattached
d)DiscloseifyouhaveeverbeenrefusedNMASAccreditationoraccreditationrenewalorhad your accreditation suspended orcancelled.
□I have never had my NMAS accreditation refused, suspended orcancelled.
□Details of the circumstances of my NMAS accreditation refusal, suspension or cancellation attached. Please include the name of the RMAB that wasinvolved.
e)DoyouagreetocomplywiththeNMASApprovalandPracticeStandardsandwithanyrelevant legislation,professionalstandardsandanyotherrequirementsthatmayapplytoyourroleasa mediator?
□Yes ☐No. Proceed no further – you must make this undertaking.
Insurance
You must have Professional Indemnity Insurance or statutory immunity through your employer.
☐I have Professional Indemnity Insurance / Name of insurer / Renewal date☐I have statutory immunity through my employer / Name of organisation
Have you met the Professional Practice Requirements for Renewal?
☐I have conducted at least 25 hours of mediation, co-mediation, FDR or conciliation since my accreditation or the last renewal of myaccreditation.
☐I haveconducted between 10 and 25 hours of mediation, co-mediation, FDR or conciliation since my accreditation or the last renewal of myaccreditation.
You will require a re-assessment of competence prior to your renewal being accepted.
-Assessment of Competence $550 Book Now
-NMAS Refresher course $650 Book Now
☐I have conducted less than 10 hours of mediation, co-mediation, family dispute resolution or conciliation in the past two years.
-You will require gap training and assessment $990 Book Now
Have you met the Professional Development Requirements for Renewal?
☐I have participated in at least 25 hours of CPD related to mediation since my accreditation or last renewal ofaccreditation.
☐I have NOT participated in 25 hours of CPD development since my accreditation or last renewal of accreditation. See the available events or volunteer for some role plays to make up the time.
Please complete this template to demonstrate your compliance with CPD requirements
CPD Evidence TemplateName: / Accreditation Period
From
To
Hours / Max / Categories / Please provide a brief overview of the type of activity
20
hrs / Participating in Education: formal, structured activities e.gconferences, courses, seminars and workshops
15
hrs / Reflecting on Practice: professional supervision, coaching or structured peer- based reflection on mediation cases.
15
hrs / Providing professional development: delivering presentations on mediation or related topics (2 hours prep for every 1-hour presentation) or providing professional supervision, assessment, coaching or mentoring mediator trainees and mediators.
10
hrs / Credit for related CPD: CPD in other disciplines such as law, behaviour or social sciences or other profession relevant to your mediation practice e.g. building or engineering
8
hrs / Learning from practice: participating in up to 4 mediations as a client representative, as a trainee co-mediator in a formal learning capacity or role playing for trainee mediators in leaning or assessment activities (2 hours per mediation)
5
hrs / Self-directed learning: private reading, listening to podcasts, watching videos, writing articles or books relevant to mediation that are published in journals or by publishers.
5
hrs / Other meaning other activities you believe are appropriate professional development.Provide details.
Total 25 hours min.
Section Three: Declarations
Declaration
☐I understand that Mediation Institute may require further information if I have disclosed criminal convictions or other impediments to my accreditation. I authorise Mediation Institute to seek information from any party noted on my application and/or supporting documents to evaluate my application.
☐I agree to the publication of my name and accreditation details on the MSB’s Register of Nationally Accredited Mediators.
☐I would like a full profile on the Mediation Institute website which will include a method for clients to contact me, a photo and my renewal date.
☐I am a FDR Practitioner – my R number is
FDR Practitioners only: By becoming a member of Mediation Institute you authorise us to notify the Attorney Generals Department if a substantiated complaint is made against you or if your NMAS accreditation lapses, is suspended or is cancelled. We will advise you our intention by the last known contact method before any notification to the Attorney Generals Department is made.
☐All information provided is correct to the best of my knowledge.
Name / DateSignature
Payment
The total fee for a 2 year renewal is $320 including any fees payable to the MSB.
Payment Amount / $320 / Card Type / ☐Visa ☐MastercardName on Card
Card Number
Expiry Date / CVV
Notes
To pay online or request an invoice go to:
new-nmas-mediator-accreditation/
Mi NMAS Accreditation Renewal FormPage 1 of 5