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Please print, type, or complete form electronically. Mediator Application.Once you have completed a certified mediation training program, an application for certification will be provided to you. Complete on separate page if needed. c. This form must be filed with the Presiding Judge for each circuit in which you intend to participate in court appointed mediation. Describe any mediation training you have received. 1 For each training, give the trainer's name, the dates attended and the total hours if available. 3. Complete this application to be listed on the Indiana Registry of Approved Court Mediators. Instructions. 1. PDF Mediation Roster Application Package Fillable and Savable Form (rev. B) Have experience in the practice of family law OR have completed a 20-hour Family Law.