joomlaforms

Volunteer Mediator Application

The Westchester County Human Rights Commission occasionally requires the services of a mediator to help resolve discrimination matters. The mediator would engage with the complainant and respondent, as well as the staff of the Human Rights Commission. Mediation would take place in our office at 112 E. Post Road, 3rd floor, White Plains, NY.

If you are a certified mediator or an attorney and would like to inquire about a volunteer position, complete the form below. You will hear from a member of our staff within a week of receipt.

Thank you for your interest and willingness to serve.

Your contact information:

will never be shared
will always be kept confidential
will never be used in any other county government application

Complete the form below. The system will prompt you if an answer is required.

First Name

Last Name

Address

City

State

Best phone

Enter phone as ###-###-####.

E-mail

If you are a trained of certified mediator, enter the name of the training or certifying agency.

Contact phone number for this organization.

Enter phone no. as ###-###-####.

Enter the date you completed your training or certification.

Enter date as mm/dd/yyyy.

Are you admitted to the NYS Bar?

No Yes

If you are admitted, enter your attorney registration number.

Do you prefer to mediate housing or employment matters?

Approximately, how many cases have you mediated?

List the types of cases you have previously mediated.

Use the dots in the lower right of the text box to expand the writing area.

Why are you interested in serving as a mediator for the Westchester County Human Rights Commission?

Use the dots in the lower right of the text box to expand the writing area.

List three references and their best contact information.

1: First name

Last name

Phone

Enter phone as ###-###-####.

E-mail

2: First name

Last name

Phone

Enter phone as ###-###-####.

E-mail

3. First name

Last name

Phone

Enter phone as ###-###-####.

E-mail

Do you have any time constaints that would impede your ability to mediate cases for the Westchester County Human Rights Commission?

You may enter up to 150 characters.

Enter the verification code in the field below in order to submit the form.

If you cannot read the code, click the circle of arrows to retrieve a different one.