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MTMA Application for
Certified Mediator with Eldercare Designation (CM/E)

PREREQUISITE. Before submitting an application for CM with Eldercare Designation, you must first earn MTMA’s Certified Mediator designation. MTMA’s Mediator Qualifications and the application for Certified Mediator is available on our website at

PRIVACY NOTE.  The contents of this application will not be sold or distributed.  Successful applicants will have their name, contact information, and sector of practice published in the MTMA online directory.  A résumé may be submitted with this application.

APPLICATION INSTRUCTIONS: Please answer the following questions.  Incomplete applications will be returned for further information.  The Qualifications committee reviews all applications within 4 weeks.  If you have questions, or qualification obstacles, please contact MTMA at 406-519-8747 or


MEMBERSHIP DESCRIPTION.  A MTMA Certified Mediator with Eldercare Designation (CM/E) is a mediator, neutral or individual dedicated to processes in which consensual and informed resolutions are made by parties.  CM/E must meet MTMA's Certified Mediator Qualifications; subscribe to MTMA's Code of Ethics and Standards of Practice; be interested in furthering the purpose of MTMA; and be current in the payment of annual dues.

MEMBERSHIP DUES and APPLICATION FEES.  $150 per year for CM with Family Designation ($125 CM dues plus $25 for the additional Family designation) plus one-time $15 non-refundable application fee. MTMA’s membership year is July 1-June 30. The $15 application fee must be paid at the time you apply for the Family designation. Application fees are non-refundable. You will be billed for the $25 additional designation fee if your application is approved.


Qualifications for Certified Eldercare Mediators

  • Currently a MTMA Certified Mediator in good standing

  • Be trained in "basic" mediation skills

  • Observation of at least 2 eldercare mediators & briefing AND

  • 8 hours co-mediation in 4 eldercare cases OR

  • 8 hours solo mediation in 4 eldercare cases with 5 hours consultation/debriefing with a CM

  • 8 hours training in Elder Care Mediation, including but not limited to, training in estate law, probate, diseases of the elderly, interpersonal conflict, gender issues, communication processes, family law, and ethics relevant to conflict involving an elder

Before filling out this application please read the full list of qualifications at MTMA Certified Mediator Qualifications.

Part 1. Enter you contact information as you wish it to be listed in the membership director. All membership materials will be sent to this address.
The information below will not be included in the MTMA directory.
Are you curretly a MTMA CM and current on your membeship dues?
Do you want a MTMA website profile page? (+$60)
Part II (A) Training
List the training you have taken to enable you to perform as a neutral. Include sponsor and dates. Please enclose copies of certificates from your mediation trainings. A resume is not proof of training. Enter whole numbers for number of hours.
Part II (B) Writing Sample
MTMA Certified Mediators are required to have effective communication skills. Please attach a maximum of two double-spaced pages of your writing that demonstrates your effective written communication skills in drafting a mediated or other consensual agreement or memorandum.
Part II (C) Skills
Please indicate whether your training in basic mediation skills included:
Choose Skills
Part II (D) Experience
Please recount your number of case and hours spent in the following post mediation training activities. Enter whole numbers for number of hours.
1. Observation of Eldercare Cases - Mediation & Other Neutral Processes



2. Co-Mediation or Supervised Medation of Eldercare Cases - Mediation & Other Neutral Processes



3. Solo Mediation of Eldercare Cases


4. Mentoring/Consultation of Eldercare Cases



Part III (E) Reference
List one reference (preferably a MTMA Member) who is familiar with your work and who may be contacted if additional information is required. Please include address and phone number.
Part IV. As a member of MTMA, I will subscribe to the purpose and principles of the Association. I will further certify the information supplied on this application is true, correct, and complete to the best of my knowledge.

Thanks for submitting!

A pay window will pop up after the application has been submitted.

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