Dayton Mediation Center-Volunteer Application

Thank you for your interest in becoming a volunteer mediator with the Dayton Mediation Center. Please review the requirements, training dates, responsibilities found on the Become a Volunteer page.

Dayton Mediation - Center Volunteer Application

Name:

Address:

City:

ZIP:

Home Phone:

Cell Phone:

Work Phone:

Email:

Highest academic grade level achieved:

How did you hear about the Dayton Mediation Center?

Work and volunteer experience:

Special skills, second language and special training:

I am interested in mediation because:

Physical limitations and special needs:

Emergency Contact Information:

Name:

Address:

Phone:

Other useful information:

We request that you mediate or assist at least once per month. We conduct most of our mediations on Saturday. We ask volunteers to pick a week of the month that is convenient to come in to mediation. Please indicate your first, second, and third Saturday of the month choices:

First

Second

Third

Fourth

Acknowledgement of Commitment to Volunteer

In exchange for mediation training, I will volunteer three hours per month for two years.