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Name
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Name
(informal - for nametag): |
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Address: |
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City: |
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State: |
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Zip Code: |
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Phone: |
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Work: |
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Fax: |
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Email Address: |
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Employer: |
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Position: |
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Accommodations Required: |
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How did you hear about The
Justice Center of Atlanta: |
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Personal Referral
Email Notice
JCA Website
Other |
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Training Date(s) Desired: |
(Click
Here for Calendar) |
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3-day
Advanced Mediation Skills, Techniques & Approaches: $725
($720, cost for federal employees) |
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1/2
day, 3-hour Continuing Education course: $85 |
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5-day
Basic Mediation Skills: $1,390 |
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5-day
Divorce & Family Mediation Skills: $1,390 |
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2-day
Advanced Divorce Practicum: $500 ($600 beginning
1/1/2013) |
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2-day
Domestic Violence: $500 ($600 beginning 1/1/2013) |
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3-day
Mediation in Special Education: $695 |
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Mentoring
for Mediators: $600
(one-on-one training for GODR registered and local residents
only - your cases are assigned after you enroll.) |
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3-day
Juvenile Delinquency $650 (required pre-requisite for
Juvenile Deprivation)($725
beginning 1/1/2013) |
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3-day
Juvenile Deprivation $650 |
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4-day
Juvenile Deprivation $895 |
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Registration & Cancellation
Policy - Please Read Carefully |
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To register for a class:
Individuals must send a registration form with full
payment by check, money order, cash, or credit card.
Government Employees may register with a check, credit
card, or purchase order (federal form: 1556 or SF 182) -
with ALL necessary signatures. JCA runs credit card
charges 3 weeks before the class begins (unless requested by
the agency to do otherwise)
Cancellation and Refund Policy - please read carefully:
Due to the high volume of requests for our classes and a
consequent necessity to create a waiting list for each
class, the following cancellation policy for all JCA classes
in 2010 is effective March 1, 2010.
You must cancel at least 7 full business days before the
training to receive a full refund.
Enrollees who cancel fewer than 7 full business days before
the class must, within 6 months, either register
for and attend another class
otherwise all payments are forfeited to the Justice
Center of Atlanta.
There is a non-refundable no-show fee. In the
case of a no-show, the class fee will not be refunded. If an SF 182 form was issued, we will invoice the
government agency the full cost of the training.
Refunds are issued to the payor of record. |
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I
understand that I must attend the full 40-hours of the Basic
Mediation Skills class to be eligible for a certificate.
I understand that my application for training at the Justice
Center of Atlanta is not an application to become a mediator
for the Justice Center of Atlanta. I also understand
that the completion of the training course conducted by the
Justice Center of Atlanta does not necessarily qualify me to
mediate for, or be accepted as, a mediator for the Justice
Center of Atlanta. |
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Date:
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Applicant Name:
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I will pay via credit card |
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I will pay via check or cash
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I will be sending in a purchase
order
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To Pay:
Contact the
registrar at 404-523-3613 x236, scan and e-mail or fax
payment information to 404-523-3936. Include an e-mail
address for the receipt. If you pay by credit card, JCA does
not run charges until a week before the class begins, unless
you request otherwise.
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If there are any questions about
my application please contact the following : |
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Phone:
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Name:
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Comments:
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