Apply for re-accreditation

Before you apply, please make sure you have evidence that during your 2-year accreditation period, you have:

• conducted at least 25 hours of mediation, co-mediation or conciliation (or at least 10 hours under special circumstance)
• completed at least 25 hours of professional development.

If you mediate outside the Dispute Resolution Branch (DRB) or Justice Services Department (JSD) you must provide evidence of your:

• mediation-related insurance, statutory indemnity or employee status

and

• professional memberships, employment or affiliations (e.g. Queensland Law Society or Bar Association).

If you need help with your application please contact us by calling (07) 3738 7015 or emailing trainingdrb@justice.qld.gov.au.

1. Can I complete this form?

   1. Are you a mediator currently accredited with the DRB? *

      • Yes
      • No

   2. You are not eligible to complete this form

      To complete this form you need to be already accredited by DRB. If you are accredited by another RMAB then you should contact us by emailing trainingdrb@justice.qld.gov.au or by calling 3738 7015.

   3. Have you completed 25 hours of professional development? *

      • Yes
      • No

   4. You are not eligible

      You must have completed 25 hours of professional development to apply for re-accreditation.

   5. Have you conducted 25 hours of mediation, co-mediation or conciliation during your 2-year accreditation period? *

      • Yes
      • No
   6. Do you wish to apply under special circumstances? * View examples of special circumstances.

      • Yes
      • No

   7. You are not eligible

      You must have conducted 25 hours (10 hours under special circumstances) of mediation, co-mediation or conciliation during your 2-year accreditation period to apply for re-accreditation. If you are unsure whether you qualify, contact us to discuss your circumstances.

   8. Please outline your reasons to be considered under special circumstances. *
Insurance, statutory indemnity or employee status
1. Do you mediate outside of the DRB branch or JSD? * Either privately or through another organisation

   • Yes
   • No
2. Do you have private professional indemnity insurance? *

   • Yes
   • No
3. Private professional indemnity insurance details

   1. Name of insurance company *
   2. Policy number *
   3. Expiry date * Example: 12/07/2017
   4. * Upload and attach a copy of your private professional indemnity insurance showing you are specifically covered for mediation Attachments must be less than 5MB in total. Approved file types are .doc .docx .pdf .odf .jpg .jpeg .bmp .tif .tiff .png .xls .xlsx
4. Do you have statutory indemnity through another employer or agency? *

   • Yes
   • No

5. You are not eligible

   If you mediate outside the Dispute Resolution Branch, you need to have either private professional indemnity insurance or statutory indemnity from another employer.

6. Employee status or statutory indemnity

   1. Name of employer *
   2. Name of second employer (if applicable)
   3. * Upload and attach a copy of a letter from your employer confirming your mediation-related employee status or statutory indemnity Attachments must be less than 5MB in total. Approved file types are .doc .docx .pdf .odf .jpg .jpeg .bmp .tif .tiff .png .xls .xlsx
Professional Affiliations
1. Do you have any professional affiliations outside of the DRB or JSD? *

   • Yes
   • No
2. 1. Mediators accredited through the DRB as their RMAB and practicing DRB panel mediators are professionally affiliated with the DRB. Practising JSD mediators or conciliators are professionally affiliated with their business unit (for example, QCAT or Body Corporate and Community Management).
   2. If you belong to another professional body such as the Queensland Law Society, please nominate the appropriate professional association(s) or organisation(s) with whom you are affiliated or employed.
   3. Details of affiliation(s) *
Mediation or conciliation log
1. Enter details of the number of hours of mediation, co-mediation or conciliation you have conducted with the DRB, JSD or elsewhere. You must have conducted at least 25 hours of mediation, co-mediation or conciliation during your 2-year accreditation period (or at least 10 hours under special circumstance).
2. If you have not kept records of the hours you have conducted with the DRB, your DRC coordinator may be able to provide a report of your hours to help you complete this application.

3. Details of mediation / conciliation
   1	Organisation: Date: Hours:
Professional development log
1. Enter details of your professional development hours. You must have completed at least 25 hours of professional development during your 2-year accreditation period.
2. View the activities that are accepted as evidence of professional development.

3. Details of development
   1	Development activity: Date: Hours: Description:
Contact details
1. Title * Mr Mrs Ms Miss Dr
2. Name

   1. Given name *
   2. Family name *
3. Is this the name you would like to appear on your certificate of accreditation? *

   • Yes
   • No
4. Preferred name for certificate (If you chose ‘No’ above)

   1. Given name *
   2. Family name *
5. Address

   1. Address line 1 *
   2. Address line 2
   3. 1. Town, city or suburb *
      2. State *
      3. Postcode *
6. Phone * Home, mobile or work number
7. Email * Example: jane.smart@example.com
Declarations
1. Under the Standards a mediator must have personal qualities and appropriate life, social and work experience to conduct the process independently and professionally. To be accredited, we require you to provide the following declarations and acknowledgements.
2. I acknowledge that the Dispute Resolution Branch RMAB is obliged to provide information concerning the status of my accreditation (including lapse, suspension, cancellation or reinstatement) to the Mediator Standards Board and may disclose information in order to ensure the National Register of Nationally Accredited Mediators is current. *

   • Yes
   • No
3. Please provide an explanation why you answered no to the above question *
4. I declare I am without any serious conviction that could influence my capacity to Discharge my obligations as a mediator in a competent, honest and appropriate manner. *

   • Yes
   • No
5. Please provide an explanation why you answered no to the above question *
6. I declare I am without any impairment that could influence my capacity to discharge my obligations as a mediator in a competent, honest and appropriate manner. *

   • Yes
   • No
7. Please provide an explanation why you answered no to the above question *
8. I declare to the best of my knowledge and belief that I have not been refused NMAS accreditation or accreditation renewal or had my accreditation suspended or cancelled. *

   • Yes
   • No
9. Please provide an explanation why you answered no to the above question *
10. I declare I have not been disqualified to practice by another professional association relating to any other profession (for example, a Law Society or a Medical Association). *

    • Yes
    • No
11. Please provide an explanation why you answered no to the above question *
12. I declare I have read and understood my obligations under the Approval Standards and the Practice Standards. *

    • Yes
    • No
13. Please provide an explanation why you answered no to the above question *
14. I declare that the content of this application is true and correct to the best of my knowledge. *

    • Yes
    • No
15. Please provide an explanation why you answered no to the above question *
16. I declare that I will notify the Dispute Resolution Branch of any changes to my circumstances that may reasonably affect this approval in the period of this accreditation. *

    • Yes
    • No
17. Please provide an explanation why you answered no to the above question *
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