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MTMA Application for Certified Mediator with additional Family Designation (CM/F)

Montana Mediation Association
Application for Certified Mediator
with additional Family Designation (CM/F)

Session ID: 14007608479402601217498595

PRIVACY NOTE.  The contents of this application will not be sold or distributed.  Successful applicants will have their name, contact information, and sector of practice published in the MtMA Directory.  A résumé may be submitted with this application.

APPLICATION INSTRUCTIONS: Please answer the following questions.  Incomplete applications will be returned for further information.  The Qualifications committee reviews all applications within 7 weeks.  If you have questions, or qualification obstacles, please contact the MtMA Administrator at 406-241-2422 or .

MEMBERSHIP DESCRIPTION.  A MtMA Certified Mediator (CM) is a mediator, neutral or individual dedicated to processes in which consensual and informed resolutions are made by parties.  CM's must meet MtMA's Certified Mediator Qualifications; subscribe to MtMA's Code of Ethics and Standards of Practice; be interested in furthering the purpose of MtMA; and be current in the payment of annual dues.

MEMBERSHIP DUES and APPLICATION FEES.  If you are not current on your dues, please enclose $95 plus $25 application fee.  If your dues are current, enclose $25 application fee.

Qualifications for Certified Family Mediators

  • 4 year degree and at least five years experience in a human services field
  • Observation of at least 2 family mediators & briefing AND
  • 8 hours co-mediation in 4 family cases OR
  • 8 hours solo mediation in 4 family cases with 5 hours consultation/debriefing with a CM
  • 24 hours training in family mediation/family law
  • 15 hours continuing education/year with a minimum of 3 hours, family related

Before filling out this application please read the full list of qualifications on our website at
Qualifications Page (PDF):

PREREQUISITE.  You must first complete all requirements to earn MtMA's Certified Mediator designation before applying to become a Certified Mediator with Additional Family Designation.  See MtMA Mediator Qualifications.  Application for Certified Mediator is available from MtMA at

PART I - Contact Information

Enter your contact information as you wish it to be listed in the membership directory.  All membership materials will be sent to this address.


First Name


Last Name

Address Line 1

Address Line 2



ZIP Code

Daytime Phone Number


Email Address

Occupation and employer information will not be printed in the membership directory.



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