FDR Centre Registration of Interest

The FDR Centre is a wholly owned subsidiary of NZDRC. The Centre was established to provide FDR services as well as comprehensive Family & Relationship Mediation, Counselling and Conflict & Communication Coaching services and Family Law Arbitration (Wills, Trusts and Estates Arbitration)

If you wish to be considered for admission to the FDR Centre's panels of Arbitrators, Mediators, Counsellors or Conflict & Communication Coaches please complete our 'Registration of Interest' (ROI) form by clicking here (Before you begin please ensure you scan through the questions and have the relevant information to hand as you will not be able to save the form and return to it later.
Please note: All questions marked with * are mandatory)

Please visit our website www.fdrc.co.nz to find out more.

FDR Centre
Daytime Phone*
Mobile Phone
Email Address*
Address*
Company Name (if applicable)
Website Address (if applicable)
MEDIATION
I am interested in providing Mediation Services for:
FDR only
FDR & general family & relationship mediation
General family & relationship mediation
I am also interested in providing Conflict & Communication Coaching
Yes
No
I am accredited to provide FDR services by
AMINZ
LEADR
NZLS
I intend to become accredited to provide FDR services
Yes
No
Number of years I have worked as a mediator
Number of mediations I have conducted
I provide professional supervision
Yes
No
COUNSELLING
I am interested in providing Counselling Services for:
Preparatory Counselling for FDR only
Preparatory Counselling for FDR and general family & relationship counselling
General family & relationship counselling only
I am also interested in providing Conflict & Communication Coaching
Yes
No
I meet the qualification and competency requirements to provide Preparatory Counselling under the Care of Children (Counselling) Regulations 2013
Yes
No
I intend to meet the qualification and competency requirements to provide Preparatory Counselling under the Care of Children (Counselling) Regulations 2013
Yes
No
I am an approved provider of 'Parenting Through Separation'
Yes
No
Number of years I have worked as a counsellor
Number of cases handled
I am presently approved to work as a counsellor for the family court*
Yes
No
GENERAL INFORMATION AND QUALIFICATIONS
I am interested in working in the following geographic locations*
Northland
Rodney
Auckland (North)
Auckland (Central)
Auckland (West)
Auckland (East)
Auckland (South)
Hauraki Gulf
Franklin
Waikato
Coromandel
Bay of Plenty
Gisbourne
Hawkes Bay
Taranaki
Manawatu-Whanganui
Wellington
Tasman
Nelson
Marlborough
West Coast
Canterbury
Otago
Southland
Stewart Island
Chatham Islands
I speak the following languages - Please record each langauge you speak along with your level of competency for each one using the following 3 options: N (Native Language) F (Fluent) C (Conversational)*
I have specific expertise in working with the following cultural, religious, ethnic or gender groups
I belong to the following professional bodies
My Qualifications are
My areas of expertise are
Parenting/Care and contact issues
Extended family issues
Repartnered/blended family issues
Adolescent/teenage issues
Gender issues
Sexuality issues
Finance and budgeting issues
Separation
Relocation
Relationship property
Pre and post nuptial agreements
Multi generational issues
Multi cultural relationships
Adult family and elder care
Illness & Disabilites
Wills & Estates
Domestic violence
Drug &/or Alcohol abuse
Other (please specify below)
If you selected 'Other' above please specify the area(s) of expertise here
I am interested in providing services for*
FDR/Parenting/Care and contact issues
Extended family issues
Repartnered/Blended family issues
Finance and budgeting issues
Separation
Relationship Property
Pre and post nuptial agreements
Multi generational issues
Elder Care
Wills & Estates
Other (please specify)
If you selected 'Other' above please specify the area(s) you wish to provide services for here
My usual hourly (GST inclusive) rate for this type of work is*
FACILITIES
I have rooms available for the provision of my services*
Yes
No
Brief description of facilities available
There is an additional charge for the use of these rooms
Yes
No
The GST inclusive cost of using these rooms is
I have rooms that the FDR Centre can hire
Yes
No
The GST inclusive cost of using these rooms is
BIO, CV & REFERENCES
Please provide a brief Bio of approx 500 words (you may enter this bio directly or upload a file in MS Word format if you prefer)
Upload Bio here
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Please upload a current CV for our records
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References: Please provide us with the names and contact details of 3 professional referees (& their relationship to you)
Please upload a jpeg image here for us to use for your online proflie.
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