Application Forms
The deadline for receipt of complete applications to be reviewed at a Board meeting is one week before the Board meeting. In addition, all fees are non-refundable.
Forms for Initial Certification as a Family Mediator
- Memo to all Initial Applicants
- Initial Application Part 1: Public Information
- Initial Application Part 2: Confidential Personal Data
- Intern Case Summary Form A separate form is required for each case submitted.
- Intern Evaluation An evaluation is required for each case submitted.
- Additional Requirements Form
- Initial Application Checklist
- Certified Mediator Listing Information
Forms for Renewal of Certification as a Family Mediator
- Renewal Application Part 1: Public Information
- Renewal Application: Confidential Personal Data
- Renewal Checklist
- Certified Mediator Listing Information
- Memo re: Extension of time to complete continuing education
Certification of Training Programs - Initial or Renewal
- Letter to Initial Applicants
- Initial Application
- Renewal Application
- Staff Information: Director
- Staff Information: Trainer
- Staff Information: NH Law Specialist
- Staff Information: DV Specialist
- Certified Training Program Listing Information
The Board's office is located in the NH Judicial Council, Room 424, State House Annex, 25 Capitol Street, Concord, NH 03301. The telephone number is (603) 271-6593. The Board's e-mail address is family.mediator@nh.gov. Messages are answered on a weekly basis.
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Family Mediator Certification Board
State House Annex, Room 424 | 25 Capitol Street | Concord, NH 03301
603-271-6593