You must have JavaScript enabled to use this form. Full Name Are you willing to be listed on our website? - Select -YesNo Short Biography Information See our website for ideas of other biographies already online. Contact Information This will be for internal purposes only. Not listed on the website. Preferred Phone Number Preferred Email Days Generally Available Sunday Monday Tuesday Wednesday Thursday Friday Saturday Notes on availability "not before 8am" or "no evenings", etc. Professional Skills and Practice Areas of Training & Competence in Conflict Navigation Areas of Training & Competence in Conflict Navigation ArbiterChurch/Organizational ConflictCirclesMediatorPeer MediationRestorative JusticeStrategies for Trauma Awareness and Resilience (STAR) PractitionerTrainer/PresenterTrust-building and Leadership TrainingOther… Enter other… Check all that apply Years of Experience Professional Website Link If applicable Do you currently provide services to individuals or groups seeking conflict mediation? - None -YesNo Specific Services Offered Family & Interpersonal Services Offered Family & Interpersonal Services Offered EldercareDivorce CustodyEstateOther… Enter other… Please check all areas of expertise and passion. Community Disputes Community Disputes Conflicts referred by courtsNeighborhood conflicts referred by law enforcementOther… Enter other… Schools Schools Peer MediationTruencyOther… Enter other… Businesses/Non-profits/Universities Businesses/Non-profits/Universities Contract OmbudsGroup FacilitationWorkplace ConflictStakeholder ConversationOther… Enter other… Faith Communities Faith Communities Congregational ConflictCongregational TransitionOther… Enter other… What are your current compensation expectations with regard to conflict mediation? Workshops & Presentations Do you have workshops or presentations you are able to give currently (with reasonable lead time)? Do you have workshops or presentations you are able to give currently (with reasonable lead time)? - None -YesNoOther… Enter other… Workshops & Presentations Detail Preferred Presentation Settings/Locations Preferred Presentation Settings/Locations SchoolsBusinesses/Non-profits/UniversitiesCivic OrganizationsFaith-based GroupsContinuing Education Credit ClassesOther… Enter other… Check all that apply. What are your current compensation expectations with regard to workshops and presentations? Workshop Outlines Please provide a description and brief outline of each workshop. Workshop Materials Upload Upload One file only.5 MB limit.Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods. Thanks for your willingness to join with Connexus to help transform the culture of conflict in Holmes and Wayne Counties! Submit
