[{"type":"header","subtype":"h1","label":"Potential Panel Member","access":false},{"type":"textarea","required":false,"label":"Potential Panel Members<div>This form is for trained mediators who require additional observations/experience/CPD for CMC registration AND who are based in the North of England.<br></div><div>IMPORTANT</div><div>To be considered for observations, you need to be an Associate member of CMC AND based in the North of England.</div><div><div><br></div><div>If you are not registered with the CMC, you can be an associate of ANM member, but you cannot be approved as a potential panel member or panel member or put forward for observations.</div></div><div><br></div>","className":"form-control","name":"textarea-1678275922355-0","access":false,"subtype":"textarea"},{"type":"text","required":true,"label":"Full Name","className":"form-control","name":"full_name","access":false,"subtype":"text"},{"type":"text","required":false,"label":"Business Name ","className":"form-control","name":"text-1678270774154","access":false,"subtype":"text"},{"type":"text","required":true,"label":"Address","className":"form-control required","name":"address","access":false,"subtype":"text"},{"type":"text","required":true,"label":"Postcode","className":"form-control required","name":"postcode","access":false,"subtype":"text"},{"type":"text","subtype":"email","required":true,"label":"Email","className":"form-control required","name":"email","access":false},{"type":"text","required":true,"label":"Preferred Contact Telephone No.","className":"form-control required","name":"phone","access":false,"subtype":"text"},{"type":"header","subtype":"h1","label":"Header","access":false},{"type":"text","required":false,"label":"Website","className":"form-control","name":"website","access":false,"subtype":"text"},{"type":"textarea","required":true,"label":"Professional qualifications relevant to the type of mediation you practice (mediation qualifications further on)","className":"form-control required","name":"qualifications","access":false,"subtype":"textarea"}]

[{"type":"header","subtype":"h3","label":"Section 1: Accreditation","access":false},{"type":"paragraph","subtype":"p","label":"<div>Details of Civil & Commercial Mediation Training</div><div><br></div><div>Note that the minimal required length of any training course is 40 hours and the course itself must be one that is recognised as meeting the current standards for Civil Mediators identified by the Civil Mediation Council (known as the ‘CMC’).</div><div><br></div><div>It is a prerequisite that all those organisations recognised as training mediators provide courses of at least four days or 40 CPD hours.</div>","access":false},{"type":"text","required":true,"label":"Details of your Civil and Commercial Training Provider including date of training","className":"form-control required","name":"training_providers","access":false,"subtype":"text"},{"type":"text","required":false,"label":"Details of of any other mediation training you have completed (Please give title of training, length, date and name of provider)","className":"form-control","name":"text-1678271004979","access":false,"subtype":"text"}]

[{"type":"header","subtype":"h3","label":"Section 2: Dispute Resolution Experience","access":false},{"type":"paragraph","subtype":"p","label":"<div>This form is for trained mediators who require additional observations/experience/CPD for CMC registration</div><div>ANM panel members must be registered as mediators with the CMC. </div><div>If you are not registered with the CMC, you can be an associate member, but you cannot be approved as a panel member or offered observations.</div>","access":false},{"type":"radio-group","required":true,"label":"Which of the following best describes you?","inline":false,"name":"radio-group-1684771180009-0","access":false,"other":false,"values":[{"label":"I'm an accredited practising mediator","value":"option-1","selected":false},{"label":"I'm a mediator who requires observations/experienceOption 2","value":"option-2","selected":false}]},{"type":"radio-group","required":true,"label":"To comply with Civil Mediation Council rules for approved mediation providers, for approval as an ANM potential panel member you must be a CMC Associate. ","inline":true,"className":"form-control required","name":"radio-group-1680789558589","access":false,"other":false,"values":[{"label":"I'm an accredited practising mediator","value":"accredited_practising_mediator","selected":false},{"label":"I'm a mediator who requires observations/experience","value":"observations_for_accreditation","selected":false}]},{"type":"radio-group","required":true,"label":"Please indicate your current membership status with the Civil Mediation Council. To be considered for observations, you need to be an Associate member of CMC.","description":"https://civilmediation.org/membership/","inline":false,"className":"form-control required","name":"radio-group-1678272068029","access":false,"other":false,"values":[{"label":"CMC Associate","value":"Associate","selected":false},{"label":"Registered Mediator","value":"Registered","selected":false},{"label":"CMC Fellow","value":"Fellow","selected":false},{"label":"CMC Friend","value":"Friend","selected":false},{"label":"CMC Student","value":"Student","selected":false}]},{"type":"text","required":false,"label":"Either CMC renewal date or date of registration","className":"form-control","name":"text-1683733267483-0","access":false,"subtype":"text"}]

[{"type":"radio-group","required":true,"label":"Have you completed your Civil and Commercial Mediation Training within the last 12 months? ","inline":true,"className":"form-control required","name":"completed_accreditation","access":false,"other":false,"values":[{"label":"Yes","value":"yes","selected":false},{"label":"No","value":"no","selected":false}]},{"type":"checkbox-group","required":true,"label":"Areas of Mediation<div>When you are approved for panel membership, we list you for up to 5 areas of experience.  If more than 5 named, first five ticked will be shown</div><div>Please select by ticking the areas in which you have expertise. </div>","toggle":false,"inline":false,"name":"checkbox-group-1683738409898-0","access":false,"other":false,"values":[{"label":"Agriculture","value":"option-1","selected":false},{"label":"Banking & Finance","value":"","selected":false},{"label":"Construction & Engineer","value":"","selected":false},{"label":"Contractual Disputes","value":"","selected":false},{"label":"Employment & Workplace","value":"","selected":false},{"label":"Media & Communication","value":"","selected":false},{"label":"Partnership","value":"","selected":false},{"label":"Personal Injury & Medical Negligence","value":"","selected":false},{"label":"Professional Negligence","value":"","selected":false},{"label":"Property","value":"","selected":false},{"label":"Small Claims","value":"","selected":false},{"label":"Trust Wills & Probate","value":"","selected":false}]}]

[{"type":"header","subtype":"h3","label":"Details of Observations","access":false},{"type":"paragraph","subtype":"p","label":"For those who have completed their approved training but have not yet done at least three observations, please answer the questions below.","access":false},{"type":"text","required":true,"label":"How many mediations have you observed?","className":"form-control required","name":"mediations_observerd","access":false,"subtype":"text"},{"type":"radio-group","required":true,"label":"Would you like us to assist in securing you observations on experience? (Please note we cannot guarantee observations)","inline":false,"className":"form-control required","name":"assist_securing_observations_experience","access":false,"other":false,"values":[{"label":"Yes","value":"yes","selected":false},{"label":"No","value":"no","selected":false}]}]

[{"type":"header","subtype":"h3","label":"Section 3: Annual Training Requirement","access":false},{"type":"paragraph","subtype":"p","label":"<div>This is a mandatory requirement for ALL applicants (panel and trainees).</div><div><br></div><div>The Association has an annual requirement that all members carry out at least 6  hours CPD training in any one calendar year. Newly qualified members can use their initial training to fulfil this commitment providing this was done within the previous 18 months or such further period as we determine if circumstances justify a longer period.</div><div>Note that the ANM provides an Online CPD programme and pre-recorded sessions may be accessed in the members area.</div><div><br></div><div>CPD should be made up so far as possible with structured mediation specific training. To make it easier to complete the details we would ask you to complete the brief confirmation. </div><div>If you have not done the 6-hour minimum then please set out the extenuating circumstances in the following space to include other mediation endeavours eg relevant committee work or involvement with mediation provider or personal circumstances justifying our carrying over the requirement into the next year. Time can only be carried forward once.</div>","access":false},{"type":"radio-group","required":true,"label":"Have you carried out at least 6 hours of CPD training within the last year?","inline":false,"className":"form-control required","name":"carried_out_cpd_training","access":false,"other":false,"values":[{"label":"Yes","value":"yes","selected":false},{"label":"No","value":"no","selected":false}]}]

[{"type":"header","subtype":"h3","label":"CPD Training Record","access":false},{"type":"text","required":true,"label":"If you have not done the 6-hour minimum then please set out the extenuating circumstances in the following space to include other mediation endeavours. These include assisting in demo mediations and mediation awareness workshops. Please include the activity, date and hours. Alternatively, if you have not spent time doing any mediation activities, please describe the circumstances justifying waiving or carrying over the requirement into the next year. Normally time can only be carried forward once, however, ANM will <div>exercise discretion in exceptional circumstances such as absences due to working abroad, illness or maternity:</div>","className":"form-control required","name":"required_training_commitment","access":false,"subtype":"text"}]

[{"type":"header","subtype":"h3","label":"Section 4: Professional Indemnity Insurance","access":false},{"type":"paragraph","subtype":"p","label":"<div>It is a requirement of all mediators practicing as panel members to comply with the minimum requirements for insurance cover identified by the CMC. This is currently £1,000,000.</div><div><br></div><div>Please confirm that you hold PI insurance of at least the above to cover your acting as a Mediator in civil and commercial mediations, and that you undertake only to take on mediations that come within the scope of your cover.</div>","access":false},{"type":"text","required":true,"label":"Name of your Insurance provider:","className":"form-control required","name":"insurance_provider","access":false,"subtype":"text"},{"type":"text","required":true,"label":"Your insurance policy number:","className":"form-control required","name":"insurance_policy_number","access":false,"subtype":"text"}]

[{"type":"header","subtype":"h3","label":"Section 5: Adherence to EU Code of Conduct for Mediators","access":false},{"type":"paragraph","subtype":"p","label":"<div>By applying to join ANM and, if accepted as a member, you agree to be bound both by the terms and conditions of its constitution and to the European Code of Conduct. For more information please visit: -</div><div><br></div><div>https://www.euromed-justice.eu/en/system/files/20090128130552_adr_ec_code_conduct_en.pdf</div>","access":false}]

[{"type":"header","subtype":"h3","label":"Signature","access":false},{"type":"paragraph","subtype":"p","label":"I confirm by signing below (digital accepted) that the above information is correct and that I also confirm adherence to ANM’s obligations under both the Data Processing Act 1996 and the General Data Protection Regulations 2017 that all data provided by or on behalf of ANM shall be used strictly for the purposes for which it is provided. I will send the necessary documentation and fee required within one week.","access":false},{"type":"text","required":true,"label":"Signed:","className":"form-control required","name":"signed","access":false,"subtype":"text"},{"type":"text","required":true,"label":"Date","className":"form-control required","name":"date","access":false,"subtype":"text"}]