Form CME1 "Application for Accreditation of Continuing Mediation Education Activity" - Arkansas

What Is Form CME1?

This is a legal form that was released by the Arkansas Judiciary - a government authority operating within Arkansas. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • The latest edition provided by the Arkansas Judiciary;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form CME1 by clicking the link below or browse more documents and templates provided by the Arkansas Judiciary.

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Download Form CME1 "Application for Accreditation of Continuing Mediation Education Activity" - Arkansas

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ARKANSAS ALTERNATIVE DISPUTE RESOLUTION COMMMISSION
625 Marshall Street, Suite 1200
Little Rock, AR 72201
Phone: (501) 682-9400 Fax: (501) 682-9410
APPLICATION FOR ACCREDITATION OF CONTINUING M E D I A T I O N EDUCATION
ACTIVITY
1.
Sponsoring Organization: ____________ ___________ Sponsor #: ________________________
Address: __________________________________ Phone #:
_
_______________
FAX #: _______________________ E-mail:
___
2.
Title of educational activity:
3.
Date(s) & location(s):
_
Registration Fee: $
___________ 5. Writing surface available: ___ yes _ _ _no
4.
6.
Delivery Method(s): ___ faculty in room with participants ___ phone to broadcast site
___ satellite ___ videotape presentation (requires moderator) ___ "live" interactive computer
webcast
7.
Advertised to: _
Mediators __ Clients __
Others (specify).
_
8.
List any admission restrictions:
_
9.
Is this an 'in-house" activity? (Access limited to members of one private organization):
____yes ____no
10.
Method of evaluation: __ participant critique __ independent evaluator __ none
11.
Description of materials to be distributed:
total pages __ before program __ after program
_ other
12.
REQUIRED ATTACHMENTS to this application:
13. Total minutes of instruction, excluding
a. Time schedule (brochure, outline, description)
breaks, meals or introductions:
b. Table of contents or equivalent
c. Faculty name(s) & credentials (if not in brochure)
General:
14. Approval by other states: granted by
denied by
_
15. Submitted by: ___ employee of sponsor/provider _
individual mediator
Mediator Name:
_
SPONSOR OBLIGATIONS: Sponsor acknowledges
and agrees to comply with Arkansas A D R
Certification #:
_
C o m m i s s i o n CME rules.
Address:
__
Sponsor Representative:
_
Signature:
Title: ________________________________________
Phone:
Date:
_
Signature:
_
CME1
ARKANSAS ALTERNATIVE DISPUTE RESOLUTION COMMMISSION
625 Marshall Street, Suite 1200
Little Rock, AR 72201
Phone: (501) 682-9400 Fax: (501) 682-9410
APPLICATION FOR ACCREDITATION OF CONTINUING M E D I A T I O N EDUCATION
ACTIVITY
1.
Sponsoring Organization: ____________ ___________ Sponsor #: ________________________
Address: __________________________________ Phone #:
_
_______________
FAX #: _______________________ E-mail:
___
2.
Title of educational activity:
3.
Date(s) & location(s):
_
Registration Fee: $
___________ 5. Writing surface available: ___ yes _ _ _no
4.
6.
Delivery Method(s): ___ faculty in room with participants ___ phone to broadcast site
___ satellite ___ videotape presentation (requires moderator) ___ "live" interactive computer
webcast
7.
Advertised to: _
Mediators __ Clients __
Others (specify).
_
8.
List any admission restrictions:
_
9.
Is this an 'in-house" activity? (Access limited to members of one private organization):
____yes ____no
10.
Method of evaluation: __ participant critique __ independent evaluator __ none
11.
Description of materials to be distributed:
total pages __ before program __ after program
_ other
12.
REQUIRED ATTACHMENTS to this application:
13. Total minutes of instruction, excluding
a. Time schedule (brochure, outline, description)
breaks, meals or introductions:
b. Table of contents or equivalent
c. Faculty name(s) & credentials (if not in brochure)
General:
14. Approval by other states: granted by
denied by
_
15. Submitted by: ___ employee of sponsor/provider _
individual mediator
Mediator Name:
_
SPONSOR OBLIGATIONS: Sponsor acknowledges
and agrees to comply with Arkansas A D R
Certification #:
_
C o m m i s s i o n CME rules.
Address:
__
Sponsor Representative:
_
Signature:
Title: ________________________________________
Phone:
Date:
_
Signature:
_
CME1