Form AOC-MED-ADR-1 "Continuing Mediator Education (Cme) Reporting Form" - Kentucky

What Is Form AOC-MED-ADR-1?

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

Form Details:

  • Released on November 1, 2018;
  • The latest edition provided by the Kentucky Court of Justice;
  • 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 AOC-MED-ADR-1 by clicking the link below or browse more documents and templates provided by the Kentucky Court of Justice.

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AOC- MED-ADR-1
For Office Use Only
Rev. 11-18
Page 1 of 1
App Rec’d ______ / ______ /______
Commonwealth of Kentucky
Court of Justice
www.courts.ky.gov
Continuing Mediator Education
App Approved ______ / ______ / ______
(CME) Reporting form
AP Part XII
A mediator is encouraged to join with other mediators and members of related professions to promote mutual professional
development. Pursuant to criteria in Rules of Administrative Procedure of the Court of Justice Part XII, Mediation
Guidelines for Court of Justice Mediators, a mediator should obtain at least four (4) hours of continuing education every
two (2) years. For additional information, please refer to www.kycourts.net.
Name: _____________________________________________________________
Today’s Date: _____________________________
Email Address: _____________________________
Address: ___________________________________________________________
___________________________________________________________
Date of
Program Title and
Education Method
Total Hours
Number of
Program
Sponsoring Organization
(As indicated below)*
(60 min = 1 hr)
Applicable Hours
*Indicate if the hours you are claiming were obtained from: (1) attending, lecturing, or teaching at a live lecture or seminar
on a topic related to the practice of mediation; (2) listening or viewing audio, or web based presentations on a topic related
to mediation; (3) co-mediating or supervising trainees as part of the trainees mentorship requirements; (4) participating as
a trainer or coach in general or family mediation trainings;(5) authoring or editing written materials submitted for publication
that have significant intellectual or practical content directly related to the practice of mediation; (6) other resources (please
specify below).
Total CME Hours =
Please return this form to:
Administrative Office of the Courts
Mediation Office
1001 Vandalay Drive
Frankfort, KY 40601
Email: mediation@kycourts.net
Print
Reset Form
AOC- MED-ADR-1
For Office Use Only
Rev. 11-18
Page 1 of 1
App Rec’d ______ / ______ /______
Commonwealth of Kentucky
Court of Justice
www.courts.ky.gov
Continuing Mediator Education
App Approved ______ / ______ / ______
(CME) Reporting form
AP Part XII
A mediator is encouraged to join with other mediators and members of related professions to promote mutual professional
development. Pursuant to criteria in Rules of Administrative Procedure of the Court of Justice Part XII, Mediation
Guidelines for Court of Justice Mediators, a mediator should obtain at least four (4) hours of continuing education every
two (2) years. For additional information, please refer to www.kycourts.net.
Name: _____________________________________________________________
Today’s Date: _____________________________
Email Address: _____________________________
Address: ___________________________________________________________
___________________________________________________________
Date of
Program Title and
Education Method
Total Hours
Number of
Program
Sponsoring Organization
(As indicated below)*
(60 min = 1 hr)
Applicable Hours
*Indicate if the hours you are claiming were obtained from: (1) attending, lecturing, or teaching at a live lecture or seminar
on a topic related to the practice of mediation; (2) listening or viewing audio, or web based presentations on a topic related
to mediation; (3) co-mediating or supervising trainees as part of the trainees mentorship requirements; (4) participating as
a trainer or coach in general or family mediation trainings;(5) authoring or editing written materials submitted for publication
that have significant intellectual or practical content directly related to the practice of mediation; (6) other resources (please
specify below).
Total CME Hours =
Please return this form to:
Administrative Office of the Courts
Mediation Office
1001 Vandalay Drive
Frankfort, KY 40601
Email: mediation@kycourts.net
Print
Reset Form