Renewing your AMDRAS accreditation – form

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Renewing your AMDRAS accreditation – form

Renewal Application as an Accredited Mediator under AMDRAS

This renewal is undertaken in accordance with the AMDRAS Standards. Please refer to AMDRAS

Full name:

Address:

City:

State:

Postcode:

Mobile:

Renewal Date

What is your current level of accreditation?

ACCREDITED MEDIATOR ADVANCED MEDIATOR LEADING MEDIATOR HONORARY LEADING MEDIATOR

Do you currently hold a specialisation? If so, select from the approved specialisations list.

Are you renewing at the same level of accreditation? (See AMDRAS Clause 45)

YES NO

If no, what level of accreditation are you applying for?

Insurance

Professional Indemnity Insurance or Statutory Immunity commensurate with your level of accredita8on is mandatory for Na8onally Accredited Mediators, AMDRAS. AMDRAS Clause 43

Are you covered by relevant professional indemnity insurance or have statutory immunity? (See AMDRAS Clause 43) (if YES, please attach your Certificate of Currency or other evidence of insurance cover).

Yes No

What is your insurance renewal date?

If No, please provide more information

Practice Hours

How many hours of dispute resolution-related practice have you facilitated as a mediator, co-mediator or third-party dispute resolver in the 24 months since your last renewal? (See AMDRAS Clause 46(c) and Appendix 1)
Note 1:You should maintain a record of your practice hours, and this can be requested by our RAP or by the AMDRAS Board.
Note 2: Practice can include up to 5 hours of intake and preparatory work to set up the dispute resolution process, as well as up to 5 hours of observing a more experienced practitioner.

< 10 hours 10 to < 20 hour 20 to < 40 hours +40 hours

If you are a Specialist Dispute Resolution Practitioner, have you met the requirement of at least 40 hours of dispute resolution practice with at least 25% being within your area of specialised practice?

Yes No

Continuing Professional Developmen

Have you kept a CPD record and met the requirements of 25 hours over two years of CPD directed at developing or maintaining the Professional Attributes? (See AMDRAS Clause 47 and Appendix 2)
Note: You should maintain a record of your CPD hours, and this can be requested by our organization or by the AMDRAS Board.

< 25 hours +25Hours

Please attach a copy of your CPD Record.

Are you applying for Adjusted Renewal Requirements?

If you have not met the Practice or CPD requirements on what basis are you applying for adjusted renewal requirements? (See AMDRAS Clause 48 )

Lack of work Opportunities Health or career circumstances Residence in a non-urban area Other barriers, including socio-cultural, to accessibility or inclusion Parental leave Leave due to family circumstances Other matters considered relevant

Adjustments sought (See AMDRAS Clause 48c)

Office Use:

1. Has the Registered Practitioner sought adjusted renewals previously? Note: Adjusted renewal can not be approved for more than 2 consecutive periods under clause 48(e)
2. Indicate the adjusted renewal application outcome, including any conditions the RAP considers appropriate. (See AMDRAS Clause 48 and 49)
Approved?

Yes No

GOOD CHARACTER and DISCLOSURE

(a) Have you at any time been disqualified from any professional practice? (See AMDRAS Clause 38(c)(i)) (if YES, please attach a detailed statement and explanation).

Yes No

(b) Do you have any unspent criminal convictions? (See AMDRAS Clause 38(c)(ii)) (if YES, please attach a detailed statement and explanation).

Yes No

(c) Do you have any impairment(s) that could influence your capacity to discharge your obligations in a competent, honest and professional manner? (See AMDRAS Clause 38(c)(iii)) (if YES, please attach a detailed statement and explanation)

Yes No

(d) Have you ever been the subject of a complaint in your role as a mediator where the complaint was upheld and conditions imposed? (if YES, please attach a detailed statement and explanation).

Yes No

(e) Have you ever been refused NMAS or AMDRAS accreditation or accreditation renewal? (See AMDRAS Clause 38(c)(iv)) (if YES, please attach a detailed statement and explanation).

Yes No

(f) Have you ever had your mediation accreditation suspended or cancelled? (See AMDRAS Clause 38(c)(v)) (if YES, please attach a detailed statement and explanation).

Yes No

(g) Are you currently registered through another RAP? You can not be registered through more than one RAP. If you are seeking a transfer, please complete a transfer form.

Yes No

ACKNOWLEDGEMENT, UNDERTAKING and CONSENT

(a) Do you acknowledge and agree to be bound by the AMDRAS Code of Ethics and Professional Practice Domains, where they do not conflict with other professional obligations?

Yes No

(b) Do you understand the Ethical Code of Practice and Complaints and Disciplinary Procedure associated with [NAME OF RAP], [Link to the Information], and agree to comply with the obligations?

Yes No

Do you consent to:

• Your personal information being disclosed to the AMDRAS Board or relevant AMDRAS-related entity; and

Yes No

• Your name, registration status, and accreditation body are released on the AMDRAS National Register; and

Yes No

• The AMDRAS Board or entity releasing the information to other AMDRAS-related en88es (but to no one else without the consent of all parties concerned).

Yes No

Payment: NMAS Members – The total fee for your 2-year is $195 including GST and the fees payable to AMDRAS (Australian Mediator and Dispute Resolution Accreditation Standards) on your behalf.
FDRP Members/Nationally Accredited Mediators – For those who hold both accreditations, the total fee for your 2- year renewal is $275 including GST. This includes the fee payable to AMDRAS on your behalf.
Please note: We require separate applications where you are applying/renewing to become an FDRP and a Nationally Accredited Mediator
We accept a direct bank deposit: Conflictsolvers BSB: 033073 Account: 195997
Or you can make a credit card payment by going to our website www.conflictsolvers.com.au and at the top of the page click on training, then on miscellaneous payment.
Please ensure you state what this payment is for. You may also call us directly and have a manual credit card payment completed by phone.

Download the AMDRAS renewal form

The Art of Solving Conflicts is age old. As long as people live and breathe, conflict will exist, occasionally rearing its ugly head.

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0412 102 801
ABN 92 926 852 129
conflictsolvers@hotmail.com
251 Flinders Lane, Melbourne 3000