2017
APPLICATION for CREDENTIAL

Application Instructions:
1. Complete the APPLICANT INFORMATION section.
2. In the CREDENTIAL DESIGNATION section check the credential designation for which you are applying. The CREDENTIAL      DESIGNATION LEVELS, REQUIREMENTS AND FEES section below shows the requirements and fees for the different      designations. Indicate if you are a volunteer mediator.
3. In the QUALIFICATIONS section, provide the requested information regarding your mediation training and your mediation       experience.
4. Read the TERMS AND CONDITIONS section.
5. Sign the APPLICANT CERTIFICATION section at the bottom of the application.
6. If you pay by PayPal, you will automatically be taken to the PayPal website to complete your payment after your click [Submit        Application] at the end of the application. If you pay by mail, send a check for the fee, a copy of your training certificate and a        paper copy of your application to the address shown at the bottom of the application. A paper copy is available by clicking        [Print Application] at the bottom of the application. You also need to click [Submit Application] at the end of the application to        complete your submission. If you have problems making your payment using PayPal, please send a check to Tasha Willis at        the address shown at the end of the form.
7. In the APPLICATION SUBMISSION section, create a copy of your application for your records and click [Submit Application] to       complete the application process.


APPLICANT INFORMATION
(NO designations or titles, please [e.g., Hon., MA, LPC, PhD, etc.])
First Name:  
Primary Contact  Phone:  
Last Name:  
Fax:  
Firm/Business or   Private Sector:  
County of  Primary  Practice:  
Street or Box #:  
Email:  
City:  
Website:  
 
State:  
Zip Code:  
 

 

CREDENTIAL DESIGNATION

Check the designation level for which you are applying. See the TMCA CREDENTIAL DESIGNATIONS AND REQUIREMENTS section below for the requirements for each level.

        

Volunteer mediator. If you are a volunteer mediator and meet the requirements shown below in the TMCA CREDENTIAL DESIGNATIONS AND REQUIREMENTS section as a volunteer mediator check the box below. By checking the box you do verify that you meet the requirements and agree to the stipulations.

I do meet the criteria as a volunteer mediator and agree to the stipulations shown below.

Volunteer:  

 

QUALIFICATIONS

Forty Hour Basic Mediation Training, must meet or exceed the TMTR training criteria.
Name of Training   Organization:  
Date of   Training:  
Advanced Mediation Training Mediation Experience
Hours:  
Number of   Mediations:  
or,
Hours of   Mediations  

 

TMCA CREDENTIAL DESIGNATIONS AND REQUIREMENTS
NOTE: The TMCA Board of Directors reserves the right to change the requirements for any Credential Designation.

Definitions
For the purposes of credential designation requirements, the following definitions shall apply:

  1. Annual - a calendar year that begins on the first day of January.
  2. Basic 40 hour training - completion of a minimum of 40 classroom hours of training pursuant to Chapter 154.052 (a) Texas Civil Practice and Remedies Code. Applicants must attest and send a copy of their certificate to TMCA that demonstrates their training meets or exceeds the current criteria of the Texas Mediation Trainers Roundtable at www.tmtr.org. If the certificate of completion is lost, or if a certificate was never issued, the applicant must provide an affidavit, executed by the instructor or other attendee, that the applicant successfully completed a 40-hour course that meets the requirements of Chapter 154.052(a) and the Texas Mediator Trainers Roundtable. The affidavit must also specify the approximate date the course was taken, the organization that offered the course, the name of the instructor(s), and a satisfactory explanation regarding why the certificate cannot be produced. If the instructor or other attendee is not available to provide such an affidavit, the applicant may provide an affidavit and other reasonable evidence of completion that includes all of the foregoing elements. It must also include a satisfactory explanation regarding why the instructor or other attendee cannot provide the affidavit. Exception: If the applicant was previously credentialed beginning 2008 or later, a copy of this training certificate or affidavit is not required.
  3. Conducted mediation - a process during which the mediator communicates with the parties to a conflict either together or separately to identify with each known party the issues in dispute and possible solutions, and to encourage and facilitate communication, reconciliation, settlement and understanding between the parties.
  4. Mediation or Hours of mediation - refers to conducted mediation as defined above.
  5. Observation of a mediation - that the person observed all of the work of a mediator during a conducted mediation without having any other role in that mediation. Observations may be included as mediation experience for up to 5 mediations or 30 hours.
  6. Training - any training which meets TMCA criteria for training. See the criteria at www.txmca.org .
  7. Continuing Education - minimum and maximum hour requirements:
    1. Three (3) hours minimum of mediation ethics
    2. Mediation Courses - no maximum number of hours
    3. Five (5) hours maximum which may be education in a subject matter area involved in the cases mediated. The subject matter education must be provided through an organization recognized by practitioners in the subject matter area for providing such training and issues certificates of completion of training. e.g. Bar Associations CLE or other Associations C.E.
    4. Four (4) hours maximum of self study in mediation
    5. Five (5) hours maximum as a trainer in mediation.


Adherence to TMCA Standards and Procedures All applicants must affirm that they have read, understand and will adhere to the TMCA Standards of Practice and Code of Ethics as well as the TMCA Grievance Rules and Procedures.

For renewal criteria for each designation, click here.

 

Requirements


Credential Designation Level

Training/Education
(basic and advanced, hours)

Experience
(either mediations or hours in mediation)

Available for pro bono mediations

 

Basic 40 hr. Mediation Course

Advanced Mediation

Mediations

Hours

Number

Distinguished Credentialed

40

40

200

1000

5

Advanced Credentialed

40

20

50

300

2

Credentialed

40

0

20

125

0

Candidate for Credentialed

40

0

<20

<125

0

Annual Fee
The annual fee for each credential level is as follows.
 
Distinguished Credentialed

$150

Advanced Credentialed

$125

Credentialed

$100

Candidate for Credential

$50

Early registration: if you apply for a credential during the early registration period, October 1 through December 31 of the year preceding the credential year, a 10% discount applies.

Volunteer Mediator

If you are a volunteer mediator and will receive no compensation for mediation services during the credential year you may qualify for a reduced fee. A volunteer mediator is defined as a pro bono mediator who receives NO compensation or consideration of any kind in the form of, but not limited to, fees, salary, trading, barter, gift, exchange of goods or services, benefits, perquisites, tokens, or cash.

If you checked the box in the CREDENTIAL DESIGNATION section indicating that you meet the criteria as a volunteer mediator you do verify that you meet the definition and will remain in that status for one calendar year. If at any time during the calendar year you receive any compensation as described in the definition of a volunteer mediator, you will immediately notify the currently designated TMCA Vice Chair, Credentialing and remit to TMCA the difference in the annual cost of credentialing based on your current designation. You understand and agree that failure to notify TMCA within a reasonable time period will be cause for filing of a grievance.

The annual fee for volunteer mediators is $25.00 regardless of the credential level, if you apply during the Early Registration period, the fee for a volunteer mediator is $22.50.

 

TERMS AND CONDITIONS FOR CREDENTIALING

1. PURPOSE AND OBJECTIVE: Texas Mediator Credentialing Association (TMCA) is a non-profit, non-governmental association that promotes quality mediation throughout Texas. TMCA provides annual voluntary credentialing for mediators in Texas. The undersigned is an applicant (Applicant) seeking one of the TMCA credential designations (Credential Designation) under the terms and conditions set forth below (Terms and Conditions).
2. MEANING AND USE OF CREDENTIAL DESIGNATION: Subject to these Terms and Conditions, TMCA grants the Applicant a non-exclusive and non-transferable right to use the Credential Designation granted to the Applicant. The Applicant may only use the Credential Designation exactly as it appears on the Applicants Certificate of Credential Designation (the Mark) in association with the Applicants name on promotional displays and advertising materials. The Applicant may not use a Credential Designation or claim to have obtained a Credential Designation from the TMCA unless the Applicant has completed the credentialing requirements. The Applicant may not use any TMCA logo or mark other than the Mark, and the TMCA reserves the right to deny use of the Mark, the TMCA logo, or any other TMCA mark at its sole discretion, at any time and for any reason. The words, spelling, case of the letters, comparative size of the words and letters, grammar, punctuation, and substance of the Mark may not be modified or altered in any way by the Applicant.
The Applicant agrees to immediately terminate the use of any Credential Designation granted by the TMCA at the request or instruction of the TMCA. Such request may be made pursuant to the TMCA Grievance Rules and Procedures or at any time and for any reason determined by the TMCA in its sole and exclusive discretion.
Inappropriate use of the Credential designation will result in the termination of the use of the Applicants Credential Designation. Such inappropriate use includes by way of example, but is not limited to, using the Credential Designation to mislead, misrepresent, imply or suggest that (1) the Applicant has obtained a Credential Designation that the Applicant has not, (2) the TMCA endorses or recommends the services provided by the Applicant or the Applicants employees, contractors or affiliates, (3) the TMCA has entered into a joint venture, partnership, or relationship with the Applicant other than having granted a Credential Designation to the Applicant, (4) the Credential Designation has any meaning or use other than that provided in this document, or (5) any other person, organization, or entity is entitled to the use or benefit of the Credential Designation granted to the Applicant.
The Applicant acknowledges that, if granted a Credential Designation by the TMCA, the Applicant is not acquiring a license, registration, or credential by, through, or under a governmental agency, and that the Credential Designation is not being acquired pursuant to a government contract.
3. ETHICS AND GRIEVANCES: The Applicant agrees to abide by the TMCA Standards of Practice and Code of Ethics, and the TMCA Grievance Rules and Procedures; and the Applicant agrees to the terms and provisions of both.
4. CONFIDENTIALITY: The Applicant understands that the matters communicated and records made in mediation are confidential. Such matters may not be disclosed to anyone without the consent of those who participated in the mediation, including the Applicant, unless otherwise provided by (1) TMCA Standards of Practice and Code of Ethics, (2) TMCA Grievance Rules and Procedures, or (3) Texas law.
5. WAIVER OF CONFIDENTIALITY: The Applicant hereby knowingly, intentionally, permanently, and expressly waives, gives up, and relinquishes any confidentiality to which the Applicant may be entitled, whether created by agreement, under the law, or the TMCA Standards of Practice and Code of Ethics, arising out of any mediation which is the subject of a grievance brought against the Applicant under the TMCA Grievance Rules and Procedures including, but not limited to, confidentiality concerning:

    1. Any communication relating to the subject matter of any civil or criminal complaint made by the Applicant or a participant in a mediation which is the subject of a grievance, whether before or after the institution of formal judicial proceedings; and
    2. any record made at such a mediation; and
    3. any agreement for confidentiality the Applicant made or participated in, in connection with such mediation.

The Waiver of Confidentiality in these Terms and Conditions is strictly limited in its application to a grievance brought under the T.M.C.A Grievance Rules and Procedures.
6. DISCLOSURE: The Applicant authorizes the parties to a mediation that is the subject of a complaint, to disclose documents and information as provided in the TMCA Grievance Rules and Procedures.
7. WAIVER OF LIABILITY: THE APPLICANT AGREES THAT THE TMCA, THE TMCA GRIEVANCE COMMITTEE, THE TMCA BOARD OF DIRECTORS, THOSE ACTING UNDER THE AUTHORITY OF THE COMMITTEE AND THE BOARD, AND THE EMPLOYEES AND REPRESENTATIVES OF THE TMCA (COLLECTIVELY THE TMCA AND ITS REPRESENTATIVES), SHALL NOT (INDIVIDUALLY OR COLLECTIVELY) BE LIABLE TO THE APPLICANT FOR ANY ACT OR OMISSION OF THE TMCA AND ITS REPRESENTATIVES (INDIVIDUALLY OR COLLECTIVELY), IN CONNECTION WITH ANY CREDENTIAL GRANTED OR DENIED TO THE APPLICANT BY THE TMCA, OR ANY GRIEVANCE BROUGHT AGAINST THE APPLICANT UNDER THE TMCA GRIEVANCE RULES AND PROCEDURES, OR IN CONNECTION WITH ANY OTHER MATTER ARISING HEREUNDER. THIS WAIVER OF LIABILITY SHALL SPECIFICALLY EXTEND TO LIABILITY CAUSED BY THE NEGLIGENCE OF THE TMCA AND ITS REPRESENTATIVES.
8. SPECIFIC WAIVER OF CONSUMER RIGHTS: THE APPLICANT WAIVES HIS OR HER RIGHTS UNDER THE DECEPTIVE TRADE PRACTICES-CONSUMER PROTECTION ACT, SECTION 17.41 ET SEQ., BUSINESS & COMMERCE CODE, A LAW THAT GIVES CONSUMERS SPECIAL RIGHTS AND PROTECTIONS. AFTER CONSULTATION WITH AN ATTORNEY OF THE APPLICANTS SELECTION, THE APPLICANT VOLUNTARILY CONSENTS TO THIS WAIVER.
9. INDEMNITY: THE APPLICANT AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE TMCA AND ITS REPRESENTATIVES FROM AND AGAINST ANY AND ALL HARM, DAMAGES, LIABILITY, CLAIMS, CAUSES OF ACTION, COSTS, EXPENSES, AND ATTORNEYS FEES INCURRED AT ANY TIME BY ANY OF THEM, AND AS THE SAME ARE INCURRED (WITH OR WITHOUT LITIGATION AND PRIOR TO, DURING OR AFTER ANY LITIGATION), AS A RESULT OF ANY ACTION OR CLAIM BROUGHT BY, THROUGH OR UNDER THE APPLICANT. THIS INDEMNITY SHALL SPECIFICALLY EXTEND TO DAMAGES (ETC.) CAUSED BY THE NEGLIGENCE OF THE TMCA AND ITS REPRESENTATIVES.
10. DISPUTE RESOLUTION PROCEDURE: In the event that any dispute or any issue, except those related to the use of any TMCA mark, shall arise between the TMCA and the Applicant, the Applicant agrees to negotiate in good faith to try and resolve said dispute. In the event that such efforts do not resolve the dispute, then the Applicant agrees to attempt to resolve the dispute in mediation. The Applicant agrees that the following dispute resolution procedure shall be used to resolve any such dispute between the Applicant and the TMCA prior to any further legal action, such as filing suit, etc.
Mediation shall be commenced by the sending of a notice that:

  1. must be in writing;
  2. must be sent to the address contained in the Application for the sending of notices; and
  3. must be made in good faith, and state with reasonable certainty and in reasonable detail all of the pertinent facts regarding the dispute.

Within fifteen (15) working days (for the purposes of this document, working days include all days except Saturday, Sunday, or any day on which the U.S. Post Office is closed) after the Dispute Resolution Procedure has been invoked by written notice, the Applicant and the TMCA shall submit to each other in writing a list of three (3) proposed mediators. The Applicant and the TMCA shall then attempt to agree upon a mediator from these lists within five (5) working days. If the Applicant and the TMCA are unable to agree within the five (5) working days allotted, then each party shall appoint a mediator (Appointed Mediator) from their list. The two Appointed Mediators shall then agree upon a mediator (Mediator) within five (5) working days following their appointment. Neither the Applicant nor the TMCA shall file suit until the Dispute Resolution Procedure is completed.
Thereafter, and as soon as is possible, the Applicant and the TMCA shall mediate at such a place and time as designated by the Mediator pursuant to Chapter 154, Civil Practice & Remedies Code. The Applicant and the TMCA shall continue the mediation until the dispute is resolved by agreement, or the Mediator declares an impasse. The Applicant and the TMCA will equally divide the cost of the mediation unless the Applicant and the TMCA agree otherwise.
The dispute resolution procedure set forth in this section shall not delay, prevent or obstruct:

  1. the Applicants immediate compliance with the terms of this agreement, or
  2. any proceeding under the TMCA Grievance Rules and Procedures.

The Dispute Resolution Procedure set forth in this section shall not apply to, or have effect in, a dispute arising out of the use of any TMCA mark, or a request or instruction issued by the TMCA pursuant to Section 2 of this document: Use of Credential Designation.
11. COMMENCEMENT AND TERM: These Terms and Conditions are effective upon:

    1. Receipt by the TMCA of the completed Application for Credential Designation; and
    2. Receipt by the TMCA of these Terms and Conditions completed and signed by the Applicant; and
    3. Issuance by the TMCA of the Certificate of Credential Designation.

The Terms and Conditions are in effect from the effective date until the earlier to occur of the following:

  1. The failure of the Applicant to timely complete the annual credentialing maintenance requirements for the Credential Designation;
  2. Notice from the TMCA that the Applicant has failed to timely comply with the annual credentialing maintenance requirements for the Credential Designation; or
  3. Notice from the TMCA that the Applicants Credential Designation has been terminated.

12. MODIFICATION: Any modification by the Applicant to these Terms and Conditions will render the document immediately null and void, and the Applicant will be denied a Credential Designation. The TMCA reserves the right to change these Terms and Conditions at any time and for any reason. Such changes will be effective on the credential renewal date following the date on which the changes are made.
13. COMMUNICATIONS AND NOTICES: All communications between (to and from) the TMCA and the Applicant in connection with these Terms and Conditions shall be in writing. The Applicant shall provide to the TMCA telephone numbers, addresses, tele-copier (fax) numbers, and email addresses through which the TMCA can communicate with the Applicant. The Applicant shall keep all contact information current with the TMCA. All notices and communications required to be given or sent by the TMCA to the Applicant pursuant to these Terms and Conditions may, in the TMCAs discretion, be given by certified mail, return receipt requested, electronically, by email to the Applicants email address, or by facsimile sent to the Applicants tele-copier (fax) number and shall be effective when placed in the mail or sent. Receipt by the TMCA of any item, matter or communication in any manner sent to the TMCA shall be considered effective and complete when actually received by the TMCA.
14. LEGAL RIGHTS: THE APPLICANT UNDERSTANDS THAT SIGNING THIS DOCUMENT CAN AFFECT THE APPLICANTS LEGAL RIGHTS AND THAT THE APPLICANT SHOULD OBTAIN INDEPENDENT LEGAL ADVICE BEFORE SIGNING.

 

APPLICANT CERTIFICATION

I CERTIFY THAT I MEET OR EXCEED ALL OF THE ATTACHED REQUIREMENTS FOR THE DESIGNATION I HAVE SELECTED, AND TO THE BEST OF MY KNOWLEDGE, ALL INFORMATION IN THIS APPLICATION IS TRUE AND CORRECT. IF ACCEPTED FOR CREDENTIAL DESIGNATION, I AGREE TO ABIDE BY THE STANDARDS OF PRACTICE AND CODE OF ETHICS ADOPTED BY THE TEXAS MEDIATOR CREDENTIALING ASSOCIATION (TMCA) AND TO SUBMIT TO ITS GRIEVANCE PROCEDURE.

BY MY SIGNATURE BELOW, I ALSO AGREE TO ADHERE TO THESE TERMS AND CONDITIONS AND I FULLY ACKNOWLEDGE THAT I AM BEING GRANTED A CREDENTIAL DESIGNATION BASED ON ACCEPTANCE OF THESE TERMS AND CONDITIONS AND THAT I WOULD NOT BE GRANTED THE CREDENTIAL DESIGNATION BUT FOR MY AGREEMENT TO ADHERE TO THESE TERMS AND CONDITIONS.

Full Name:  
Date:  
Please insert your full name and the current date here to electronically sign this application.

 

PAYMENT METHOD



Early Application Fee:
A 10% discount will be automatically applied if you are applying between October 1st and December 31st.
USERNAME AND PASSWORD
Username:  
Password:  
Retype Password:  

 

SUBMISSION INSTRUCTIONS
In order to receive credentialing, an applicant must submit three items: the completed Application for a Credential with the Terms and Conditions for Credentialing agreement signed and dated, a copy of the applicants Forty (40) Hour Basic Training Certificate and payment of the fee. (exception: if previously credentialed beginning January 1, 2008 or later, a copy of this Training Certificate is not required)

Paying by PayPal
If paying by PayPal, once you click [Submit Application] below and complete your PayPal payment you will still need to mail, fax or email a copy of your training certificate to the address below and with that your submission will be complete. You will be notified when your credential is approved.

Paying by Check
If paying by check, mail a check, payable to TMCA in the amount of the fee to the address below. For fees, see the Annual Fee table above. Include a copy of your training certificate, and a paper copy of your application. A paper copy is available by clicking [Print Form] below. You will be notified when your credential is approved.

Mail check and a paper copy of your Application form to:
         TMCA c/o Tasha Willis
         4604 Calhoun Rd., Suite 102 BLB, Houston, TX 77204-6060
         713-743-2066 (phone)
         713-743-2097 (fax)
         credentialing@txmca.org

 

APPLICATION SUBMISSION

Click Print Application to create a copy of the
application for your records.

Print Application