{"id":227277,"date":"2022-04-07T18:15:16","date_gmt":"2022-04-07T08:15:16","guid":{"rendered":"https:\/\/www.relationships.org.au\/?page_id=227277"},"modified":"2022-04-27T15:15:59","modified_gmt":"2022-04-27T05:15:59","slug":"ec-training","status":"publish","type":"page","link":"https:\/\/www.relationships.org.au\/ec-training\/","title":{"rendered":"Eldercaring Coordinator Training"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; _builder_version=&#8221;4.15&#8243; _module_preset=&#8221;default&#8221; background_color=&#8221;rgba(41,57,56,0.2)&#8221; background_image=&#8221;https:\/\/www.relationships.org.au\/wp-content\/uploads\/news-hero-background.png&#8221; background_blend=&#8221;overlay&#8221; min_height=&#8221;450px&#8221; max_height=&#8221;450px&#8221; collapsed=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_row column_structure=&#8221;3_5,2_5&#8243; _builder_version=&#8221;4.15&#8243; _module_preset=&#8221;default&#8221; position_origin_r=&#8221;bottom_left&#8221; vertical_offset=&#8221;-80px&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;3_5&#8243; _builder_version=&#8221;4.15&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.15.1&#8243; _module_preset=&#8221;default&#8221; header_2_font=&#8221;|600|||||||&#8221; background_layout=&#8221;dark&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h2 id='eldercaring-coordinator-training'  id=\"boomdevs_1\" >Eldercaring Coordinator Training<\/h2>\n<p>[\/et_pb_text][\/et_pb_column][et_pb_column type=&#8221;2_5&#8243; _builder_version=&#8221;4.15&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; _builder_version=&#8221;4.15.1&#8243; _module_preset=&#8221;default&#8221; background_color=&#8221;#9DDAE4&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_row column_structure=&#8221;1_2,1_2&#8243; _builder_version=&#8221;4.15.1&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;1_2&#8243; _builder_version=&#8221;4.15.1&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.15.1&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<p><strong>BE AMONG THE FIRST AUSTRALIANS TO RECEIVE ELDERCARING COORDINATION TRAINING<\/strong><\/p>\n<p>The first Eldercaring Coordination training in Australia will take place on the following dates:<\/p>\n<ul>\n<li>May 24, 25,<\/li>\n<li>June 1, 2, and<\/li>\n<li>June 7, 8.<\/li>\n<\/ul>\n<p><strong>REGISTRATION:<\/strong><\/p>\n<p>To register, submit <b>both <\/b>the Registration form and the Eldercaring Coordinator (EC) Application form (both available below). Your eligibility will then be assessed and you will be contacted regarding the progress of your application.<\/p>\n<p>If you require a paper form, please contact Relationships Australia National Office at natoffice@relationships.org.au<\/p>\n<p>Click here to read more.<\/p>\n<p>[\/et_pb_text][\/et_pb_column][et_pb_column type=&#8221;1_2&#8243; _builder_version=&#8221;4.15.1&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.15.1&#8243; _module_preset=&#8221;default&#8221; hover_enabled=&#8221;0&#8243; global_colors_info=&#8221;{}&#8221; sticky_enabled=&#8221;0&#8243;]<\/p>\n<p><strong>VIRTUAL\u00a0 <\/strong><\/p>\n<p>Zoom Platform &#8211; class size limited.<\/p>\n<p><strong>COURSE CONTENT<\/strong><\/p>\n<ul>\n<li>6.5 hours asynchronous learning assignments before in-class portion begins<\/li>\n<li>6 virtual training sessions (In-Class): 9:00 a.m. \u2013 1:00 p.m. Adelaide time<\/li>\n<\/ul>\n<p>Asynchronous learning assignments will be sent to you upon verification of eligibility to take this course.<\/p>\n<p><strong>TRAINING FEE: <\/strong><\/p>\n<p>$1000.00 AU<\/p>\n<p><strong>Registration fee will be invoiced on acceptance of Eldercaring Coordinator (EC) Training application. <\/strong><\/p>\n<p><strong>Cancellation Policy:<\/strong> Registration fees will be applied to a future Eldercaring Coordinator Training.<\/p>\n<p>&nbsp;<\/p>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row column_structure=&#8221;1_4,3_4&#8243; _builder_version=&#8221;4.15.1&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;1_4&#8243; _builder_version=&#8221;4.15.1&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.15.1&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h3 id='a-dispute-resolution-option-for-families-in-high-conflict-regarding-the-care-and-safety-of-their-aging-loved-ones'  id=\"boomdevs_2\" ><strong>A dispute resolution option for families\u00a0<\/strong><strong>in high conflict\u00a0<br \/><\/strong><strong>regarding the care and safety of their aging loved ones.<\/strong><\/h3>\n<p>[\/et_pb_text][\/et_pb_column][et_pb_column type=&#8221;3_4&#8243; _builder_version=&#8221;4.15.1&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.15.1&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<p>This practical training focuses on the application of the eldercaring coordination process and builds upon the prior knowledge, skills, training and experience of participants. The training parameters and objectives establish eldercaring coordination as a unique interdisciplinary process. \u00a0In order to enhance the professional practice and confidence of new eldercaring coordinators, this training provides an integrated experience focused on learning and applying eldercaring coordination skills and techniques throughout all of the phases of the process.<\/p>\n<p>Upon completion of this training, participants will be able to explain all of the following: 1) overview of eldercaring coordination process; 2) context and accountability for the eldercaring coordination process in AU; \u00a0\u00a03) orientation phase of the eldercaring coordination process; 4) capacity considerations and screening during eldercaring coordination; 5) the elder within the context of eldercaring coordination; 6) the engagement phase of the eldercaring coordination process; 7) high conflict family dynamics and conflict management phase of the eldercaring coordination process; 7) elder abuse, neglect, exploitation, substance abuse and family violence as it pertains to eldercaring coordination; 8) application phase of the eldercaring coordination process; 9) integration phase of the eldercaring coordination process; 10) ethical considerations pertaining to eldercaring coordination<\/p>\n<p><strong>ELDERCARING COORDINATOR TRAINERS:<\/strong><\/p>\n<p><strong>Sue Bronson, M.S., LCSW, Co-Chair of the Eldercaring Coordination Initiative<\/strong>, is a trainer and mediator of family, elder, and workplace disputes in Milwaukee, WI since 1983. Sue has \u00a036 years\u2019 experience as a psychotherapist and mediator helping people engage in\u00a0quality conversations. She teaches mediation at the University of Wisconsin &#8211; Milwaukee School of Continuing Education. Sue is the lead author of Self-Assessment Tool for Mediators translated into three languages.<\/p>\n<p><strong>Linda Fieldstone, M.Ed., Co-Chair of the Eldercaring Coordination Initiative<\/strong>, former Supervisor of Family Court Services (11th Judicial Circuit, Miami-Dade County, Florida), was instrumental in the development of parenting coordination. Linda is past President of the Association of Family and Conciliation Courts and its Florida Chapter; Secretary of the AFCC Task Force on Parenting Coordination and Co-recorder for the Task Force to update standards; and is on the Florida Supreme Court ADR Rules and Policy Committee<\/p>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row column_structure=&#8221;2_5,3_5&#8243; _builder_version=&#8221;4.15.1&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;2_5&#8243; _builder_version=&#8221;4.15.1&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.15.1&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<p><strong>ELIGIBILITY REQUIREMENTS:<\/strong> Please submit the AU Eldercaring Coordinator (EC) Application (below) along with your registration to verify your eligibility to take this training.<\/p>\n<ul>\n<li><strong>A minimum of 3 years practical experience<\/strong> in a profession that provided you with education, training and expertise in managing high conflict within families<\/li>\n<li><strong>Family Mediation<\/strong> <strong>Education and Training:<\/strong> Please confirm that you hold at least <u>one<\/u> of the following qualifications:\n<ul>\n<li>Accreditation by the Australian Attorney-General\u2019s Department as a Family Dispute Resolution Practitioner<\/li>\n<li>Attainment of a one-year graduate diploma in family mediation<\/li>\n<li>An approved Family Dispute Resolution Practitioner in New Zealand.<\/li>\n<\/ul>\n<\/li>\n<li>Completion of a minimum of <strong>20 hours <\/strong><strong>of elder mediation training<\/strong> by an Elder Mediation International Network (EMIN) Certified Elder Mediator (Advanced) which contributes to the Elder Mediator Certification requirements of the Elder Mediation Australasian Network (EMAN) and (EMIN).<\/li>\n<\/ul>\n<p>This training meets the ACR\/FLAFCC Guidelines on Eldercaring Coordination 28-hour Eldercaring Coordination Training and fulfills the qualifications needed for an Eldercaring Coordinator to practice eldercaring coordination in Australia.<\/p>\n<p>[\/et_pb_text][\/et_pb_column][et_pb_column type=&#8221;3_5&#8243; _builder_version=&#8221;4.15.1&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.15.1&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<script type=\"text\/javascript\">var 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name='input_5.6' id='input_3_5_6'   aria-required='false'    ><option value='' selected='selected'><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctica' >Antarctica<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' 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d&#039;Ivoire<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Eswatini' >Eswatini<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Falkland Islands' >Falkland Islands<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Guiana' >French Guiana<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='French Southern Territories' >French Southern Territories<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Heard Island and McDonald Islands' >Heard Island and McDonald Islands<\/option><option value='Holy See' >Holy See<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jersey' >Jersey<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='Korea, Democratic People&#039;s Republic of' >Korea, Democratic People&#039;s Republic of<\/option><option value='Korea, Republic of' >Korea, Republic of<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Lao People&#039;s Democratic Republic' >Lao People&#039;s Democratic Republic<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macao' >Macao<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Caledonia' >New Caledonia<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Norfolk Island' >Norfolk Island<\/option><option value='North Macedonia' >North Macedonia<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Romania' >Romania<\/option><option value='Russian Federation' >Russian Federation<\/option><option value='Rwanda' >Rwanda<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Helena, Ascension and Tristan da Cunha' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre and Miquelon' >Saint Pierre and Miquelon<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='South Georgia and the South Sandwich Islands' >South Georgia and the South Sandwich Islands<\/option><option value='South Sudan' >South Sudan<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Suriname' >Suriname<\/option><option value='Svalbard and Jan Mayen' >Svalbard and Jan Mayen<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria Arab Republic' >Syria Arab Republic<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania, the United Republic of' >Tanzania, the United Republic of<\/option><option value='Thailand' >Thailand<\/option><option value='Timor-Leste' >Timor-Leste<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks and Caicos Islands' >Turks and Caicos Islands<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='T\u00fcrkiye' >T\u00fcrkiye<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='United States' >United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Viet Nam' >Viet Nam<\/option><option 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id='gform_wrapper_4' >\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">Eldercaring Coordinator Application & Declaration<\/h2>\n                            <p class='gform_description'>Application and Declaration Form<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_4'  action='\/wp-json\/wp\/v2\/pages\/227277' data-formid='4' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_4' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_4_2\" class=\"gfield gfield--type-name gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_2\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Name<\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_4_2'>\n                            \n                            <span id='input_4_2_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_2.3' id='input_4_2_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_4_2_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_4_2_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_2.6' id='input_4_2_6' value=''   aria-required='false'     \/>\n                                                    <label for='input_4_2_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_4_7\" class=\"gfield gfield--type-post_custom_field gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_7\" ><label class='gfield_label gform-field-label' for='input_4_7'>Organisation<\/label><div class='ginput_container ginput_container_text'><input name='input_7' id='input_4_7' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_4_61\" class=\"gfield gfield--type-post_custom_field gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_61\" ><label class='gfield_label gform-field-label' for='input_4_61'>Position Held<\/label><div class='ginput_container ginput_container_text'><input name='input_61' id='input_4_61' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_4_62\" class=\"gfield gfield--type-email gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_62\" ><label class='gfield_label gform-field-label' for='input_4_62'>Email<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_62' id='input_4_62' type='email' value='' class='large'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_4_58\" class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_58\" ><label class='gfield_label gform-field-label' for='input_4_58'>Phone number<\/label><div class='ginput_container ginput_container_text'><input name='input_58' id='input_4_58' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_4_8\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_8\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >ELDERCARING COORDINATOR REQUIREMENTS  |  Check all those successfully completed<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_4_8'><div class='gchoice gchoice_4_8_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_8.1' type='checkbox'  value='A minimum of 3 years practical experience in a profession which provided you with education, training and expertise in managing high conflict within families;'  id='choice_4_8_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_8_1' id='label_4_8_1' class='gform-field-label gform-field-label--type-inline'>A minimum of 3 years practical experience in a profession which provided you with education, training and expertise in managing high conflict within families;<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_8_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_8.2' type='checkbox'  value='Completion of a minimum of 20 hours of elder mediation training by an Elder Mediation International Network (EMIN) Certified Elder Mediator (Advanced) which contributes to the Elder Mediator Certification requirements of the Elder Mediation Australasian Network (EMAN) and (EMIN).'  id='choice_4_8_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_8_2' id='label_4_8_2' class='gform-field-label gform-field-label--type-inline'>Completion of a minimum of 20 hours of elder mediation training by an Elder Mediation International Network (EMIN) Certified Elder Mediator (Advanced) which contributes to the Elder Mediator Certification requirements of the Elder Mediation Australasian Network (EMAN) and (EMIN).<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_8_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_8.3' type='checkbox'  value='Completion of, or enrolment in, 28-hour Eldercaring Coordinator training certified or approved by the jurisdiction or state, commensurate with the objectives established by the Association of Conflict Resolution Guidelines for Eldercaring Coordination'  id='choice_4_8_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_8_3' id='label_4_8_3' class='gform-field-label gform-field-label--type-inline'>Completion of, or enrolment in, 28-hour Eldercaring Coordinator training certified or approved by the jurisdiction or state, commensurate with the objectives established by the Association of Conflict Resolution Guidelines for Eldercaring Coordination<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_4_46\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_46\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >FAMILY AND MEDIATION EDUCATION AND TRAINING  |  Check all those successfully completed<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_4_46'><div class='gchoice gchoice_4_46_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_46.1' type='checkbox'  value='Accreditation by the Australian Attorney-General\u2019s Department as a Family Dispute Resolution Practitioner'  id='choice_4_46_1'   aria-describedby=\"gfield_description_4_46\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_4_46_1' id='label_4_46_1' class='gform-field-label gform-field-label--type-inline'>Accreditation by the Australian Attorney-General\u2019s Department as a Family Dispute Resolution Practitioner<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_46_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_46.2' type='checkbox'  value='An approved Family Dispute Resolution Practitioner in New Zealand'  id='choice_4_46_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_46_2' id='label_4_46_2' class='gform-field-label gform-field-label--type-inline'>An approved Family Dispute Resolution Practitioner in New Zealand<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_46_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_46.3' type='checkbox'  value='Attainment of a one-year graduate diploma in family mediation'  id='choice_4_46_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_46_3' id='label_4_46_3' class='gform-field-label gform-field-label--type-inline'>Attainment of a one-year graduate diploma in family mediation<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_4_46'>Please confirm that you hold at least one of the above qualifications:<\/div><\/fieldset><fieldset id=\"field_4_9\" class=\"gfield gfield--type-list gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_9\" ><legend class='gfield_label gform-field-label' >Description of Courses or Trainings above<\/legend><div class='ginput_container ginput_container_list ginput_list '><div class='gfield_list gfield_list_container'><div class=\"gfield_list_groups\"><div class='gfield_list_row_odd gfield_list_group gform-grid-row'><div class='gfield_list_group_item gfield_list_cell gfield_list_9_cell1 gform-grid-col' ><input aria-invalid='false'   aria-label='Description of Courses or Trainings above, Row 1' data-aria-label-template='Description of Courses or Trainings above, Row {0}' type='text' name='input_9[]' value=''   \/><\/div><div class='gfield_list_icons gform-grid-col'>   <button type=\"button\"  class='add_list_item ' aria-label='Add another row' onclick='gformAddListItem(this, 0)'>Add<\/button>   <button type=\"button\"  class='delete_list_item' aria-label='Remove row 1' data-aria-label-template='Remove row {0}' onclick='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\">Remove<\/button><\/div><\/div><\/div><\/div><\/div><\/fieldset><fieldset id=\"field_4_10\" class=\"gfield gfield--type-list gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_10\" ><legend class='gfield_label gform-field-label' >Trainer Name or Entity<\/legend><div class='ginput_container ginput_container_list ginput_list '><div class='gfield_list gfield_list_container'><div class=\"gfield_list_groups\"><div class='gfield_list_row_odd gfield_list_group gform-grid-row'><div class='gfield_list_group_item gfield_list_cell gfield_list_10_cell1 gform-grid-col' ><input aria-invalid='false'   aria-label='Trainer Name or Entity, Row 1' data-aria-label-template='Trainer Name or Entity, Row {0}' type='text' name='input_10[]' value=''   \/><\/div><div class='gfield_list_icons gform-grid-col'>   <button type=\"button\"  class='add_list_item ' aria-label='Add another row' onclick='gformAddListItem(this, 0)'>Add<\/button>   <button type=\"button\"  class='delete_list_item' aria-label='Remove row 1' data-aria-label-template='Remove row {0}' onclick='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\">Remove<\/button><\/div><\/div><\/div><\/div><\/div><\/fieldset><fieldset id=\"field_4_59\" class=\"gfield gfield--type-list gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_59\" ><legend class='gfield_label gform-field-label' >Date<\/legend><div class='ginput_container ginput_container_list ginput_list '><div class='gfield_list gfield_list_container'><div class=\"gfield_list_groups\"><div class='gfield_list_row_odd gfield_list_group gform-grid-row'><div class='gfield_list_group_item gfield_list_cell gfield_list_59_cell1 gform-grid-col' ><input aria-invalid='false'   aria-label='Date, Row 1' data-aria-label-template='Date, Row {0}' type='text' name='input_59[]' value=''   \/><\/div><div class='gfield_list_icons gform-grid-col'>   <button type=\"button\"  class='add_list_item ' aria-label='Add another row' onclick='gformAddListItem(this, 0)'>Add<\/button>   <button type=\"button\"  class='delete_list_item' aria-label='Remove row 1' data-aria-label-template='Remove row {0}' onclick='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\">Remove<\/button><\/div><\/div><\/div><\/div><\/div><\/fieldset><div id=\"field_4_12\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_12\" ><h3 class=\"gsection_title\"><\/h3><\/div><fieldset id=\"field_4_15\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_15\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >DECLARTION<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_4_15'><div class='gchoice gchoice_4_15_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_15.1' type='checkbox'  value='I will comply with any federal or state law that prohibits discrimination.'  id='choice_4_15_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_15_1' id='label_4_15_1' class='gform-field-label gform-field-label--type-inline'>I will comply with any federal or state law that prohibits discrimination.<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_15_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_15.2' type='checkbox'  value='I have not been a respondent in any application for protection against child abuse, elder abuse or exploitation, domestic, sexual, or repeat violence or stalking'  id='choice_4_15_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_15_2' id='label_4_15_2' class='gform-field-label gform-field-label--type-inline'>I have not been a respondent in any application for protection against child abuse, elder abuse or exploitation, domestic, sexual, or repeat violence or stalking<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_15_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_15.3' type='checkbox'  value='I shall discontinue service and immediately report to the court if I no longer meet the minimum qualifications, or if any disqualifying circumstances occur'  id='choice_4_15_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_15_3' id='label_4_15_3' class='gform-field-label gform-field-label--type-inline'>I shall discontinue service and immediately report to the court if I no longer meet the minimum qualifications, or if any disqualifying circumstances occur<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_15_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_15.4' type='checkbox'  value='I shall adhere to the ACR Eldercaring Coordinator Ethical Guidelines and be a fit and proper person to perform the requirements of the Eldercaring Coordinator role in an ethical, responsible and effective manner'  id='choice_4_15_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_15_4' id='label_4_15_4' class='gform-field-label gform-field-label--type-inline'>I shall adhere to the ACR Eldercaring Coordinator Ethical Guidelines and be a fit and proper person to perform the requirements of the Eldercaring Coordinator role in an ethical, responsible and effective manner<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_15_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_15.5' type='checkbox'  value='Has a statutory agency in the Commonwealth, a State or Territory removed you from its roster of qualified eldercaring coordinators?  If so, state date removed, and reason for the removal.'  id='choice_4_15_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_15_5' id='label_4_15_5' class='gform-field-label gform-field-label--type-inline'>Has a statutory agency in the Commonwealth, a State or Territory removed you from its roster of qualified eldercaring coordinators?  If so, state date removed, and reason for the removal.<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_4_50\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_50\" ><h3 class=\"gsection_title\">EXPERIENCE<\/h3><\/div><div id=\"field_4_18\" class=\"gfield gfield--type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_18\" ><label class='gfield_label gform-field-label' for='input_4_18'>Describe your areas of practice or specialty<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_18' id='input_4_18' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_4_20\" class=\"gfield gfield--type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_20\" ><label class='gfield_label gform-field-label' for='input_4_20'>Describe your family and elder dispute resolution experience<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_20' id='input_4_20' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_4_19\" class=\"gfield gfield--type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_19\" ><label class='gfield_label gform-field-label' for='input_4_19'>Describe any other professional experience you have that is pertinent to your expertise and\/or competence as an eldercaring coordinator, (e.g. work with elders and\/or families, parenting coordination)<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_19' id='input_4_19' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_4_21\" class=\"gfield gfield--type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_21\" ><label class='gfield_label gform-field-label' for='input_4_21'>Detail any additional expertise and training that will enhance your ability to address specific issues as an Eldercaring Coordinator, (e.g. family theory, practice and skills; elder abuse and exploitation; screening for elder abuse, domestic or family violence; substance abuse; capacity issues; medical issues related to aging; legal issues; financial issues, etc.)<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_21' id='input_4_21' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_4_22\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_22\" ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_4_51\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_51\" ><h3 class=\"gsection_title\">Location and Service Delivery<\/h3><\/div><div id=\"field_4_48\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_48\" ><label class='gfield_label gform-field-label' for='input_4_48'>List the primary jurisdictions\/territories in which you are able to provide services once qualified as an eldercaring coordinator<\/label><div class='ginput_container ginput_container_text'><input name='input_48' id='input_4_48' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_4_23\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_23\" ><label class='gfield_label gform-field-label' for='input_4_23'>List any additional locations where you can provide eldercaring coordination services.<\/label><div class='ginput_container ginput_container_text'><input name='input_23' id='input_4_23' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_4_24\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_24\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Are you willing to work on cases with an active domestic or family violence injunction or an Apprehended Personal Violence Orders (or equivalent)?<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_4_24'><div class='gchoice gchoice_4_24_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.1' type='checkbox'  value='YES'  id='choice_4_24_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_24_1' id='label_4_24_1' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_24_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.2' type='checkbox'  value='NO'  id='choice_4_24_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_24_2' id='label_4_24_2' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_4_26\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_26\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Are you willing to work on cases via telephone or video conference for parties who cannot attend meetings in-person?<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_4_26'><div class='gchoice gchoice_4_26_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.1' type='checkbox'  value='YES'  id='choice_4_26_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_26_1' id='label_4_26_1' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_26_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.2' type='checkbox'  value='NO'  id='choice_4_26_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_26_2' id='label_4_26_2' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_4_27\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_27\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Are you willing to work in a setting other than your office, including the older person\u2019s home or care facility?<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_4_27'><div class='gchoice gchoice_4_27_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_27.1' type='checkbox'  value='YES'  id='choice_4_27_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_27_1' id='label_4_27_1' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_27_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_27.2' type='checkbox'  value='NO'  id='choice_4_27_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_27_2' id='label_4_27_2' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_4_28\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_28\" ><label class='gfield_label gform-field-label' for='input_4_28'>State any locations in the jurisdiction in which you are applying to provide services in which you are not willing or able to provide those services<\/label><div class='ginput_container ginput_container_text'><input name='input_28' id='input_4_28' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_4_29\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_29\" ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_4_63\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_63\" ><label class='gfield_label gform-field-label' for='input_4_63'>FEE STRUCTURE | Please provide an indicative rate of compensation as an eldercaring coordinator (if known) - $<\/label><div class='ginput_container ginput_container_text'><input name='input_63' id='input_4_63' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_4_54\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_54\" ><legend class='gfield_label gform-field-label' >Will you charge a retainer fee?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_54'>\n\t\t\t<div class='gchoice gchoice_4_54_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_54' type='radio' value='Yes'  id='choice_4_54_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_54_0' id='label_4_54_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_54_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_54' type='radio' value='No'  id='choice_4_54_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_54_1' id='label_4_54_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_4_36\" class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_36\" ><label class='gfield_label gform-field-label' for='input_4_36'>If yes, state the amount<\/label><div class='ginput_container ginput_container_text'><input name='input_36' id='input_4_36' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_4_55\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_55\" ><legend class='gfield_label gform-field-label' >Are you willing to accept pro bono or sliding fee appointments?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_55'>\n\t\t\t<div class='gchoice gchoice_4_55_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_55' type='radio' value='Yes'  id='choice_4_55_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_55_0' id='label_4_55_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_55_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_55' type='radio' value='No'  id='choice_4_55_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_55_1' id='label_4_55_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_4_37\" class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_37\" ><label class='gfield_label gform-field-label' for='input_4_37'>If yes, specify the conditions<\/label><div class='ginput_container ginput_container_text'><input name='input_37' id='input_4_37' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_4_39\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_39\" ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_4_56\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_56\" ><h3 class=\"gsection_title\">Criminal History<\/h3><\/div><fieldset id=\"field_4_38\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_38\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >If you answer YES to any of the questions below, provide a separate written explanation and copies of all relevant documentation of each item including date, location, crime or incident and action and attach it to form<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_4_38'><div class='gchoice gchoice_4_38_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_38.1' type='checkbox'  value='As an adult, I have been charged with a serious offence or found guilty of any offence, including driving while under the influence of alcohol or drugs, reckless driving, or driving without a license or driving an unregistered vehicle.  (You are not required to disclose traffic offences that resulted in a fine only)'  id='choice_4_38_1'   aria-describedby=\"gfield_description_4_38\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_4_38_1' id='label_4_38_1' class='gform-field-label gform-field-label--type-inline'>As an adult, I have been charged with a serious offence or found guilty of any offence, including driving while under the influence of alcohol or drugs, reckless driving, or driving without a license or driving an unregistered vehicle.  (You are not required to disclose traffic offences that resulted in a fine only)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_38_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_38.2' type='checkbox'  value='I have criminal charges or warrants pending against me or am on probation or parole in this state\/territory or any other state\/territory'  id='choice_4_38_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_38_2' id='label_4_38_2' class='gform-field-label gform-field-label--type-inline'>I have criminal charges or warrants pending against me or am on probation or parole in this state\/territory or any other state\/territory<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_38_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_38.3' type='checkbox'  value='I have been found in contempt of Court'  id='choice_4_38_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_38_3' id='label_4_38_3' class='gform-field-label gform-field-label--type-inline'>I have been found in contempt of Court<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_38_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_38.4' type='checkbox'  value='I have been investigated for abuse, neglect or exploitation of a child or vulnerable adult in a jurisdiction'  id='choice_4_38_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_38_4' id='label_4_38_4' class='gform-field-label gform-field-label--type-inline'>I have been investigated for abuse, neglect or exploitation of a child or vulnerable adult in a jurisdiction<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_4_38'> <\/div><\/fieldset><div id=\"field_4_41\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_41\" ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_4_30\" class=\"gfield gfield--type-number gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_30\" ><label class='gfield_label gform-field-label' for='input_4_30'>Please enter a number between 1 and 100<\/label><div class='ginput_container ginput_container_number'><input name='input_30' id='input_4_30' type='number' step='any'   value='' class='large'      aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_4_60\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_60\" ><h3 class=\"gsection_title\">Supporting documentation<\/h3><\/div><fieldset id=\"field_4_40\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_40\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Please check the following required documents attached to your application<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_4_40'><div class='gchoice gchoice_4_40_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_40.1' type='checkbox'  value='Your current professional license(s) and\/or certification'  id='choice_4_40_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_40_1' id='label_4_40_1' class='gform-field-label gform-field-label--type-inline'>Your current professional license(s) and\/or certification<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_40_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_40.2' type='checkbox'  value='Proof of completion of family mediation education and training'  id='choice_4_40_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_40_2' id='label_4_40_2' class='gform-field-label gform-field-label--type-inline'>Proof of completion of family mediation education and training<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_40_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_40.3' type='checkbox'  value='Proof of completion of elder mediation training'  id='choice_4_40_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_40_3' id='label_4_40_3' class='gform-field-label gform-field-label--type-inline'>Proof of completion of elder mediation training<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_40_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_40.4' type='checkbox'  value='Proof of completion of eldercaring coordination training'  id='choice_4_40_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_40_4' id='label_4_40_4' class='gform-field-label gform-field-label--type-inline'>Proof of completion of eldercaring 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name='input_40.7' type='checkbox'  value='(Optional) Any other information that you feel might be relevant (e.g. a brief description of any other special education, training or experience that might enhance your performance as an Eldercaring Coordinator)'  id='choice_4_40_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_40_7' id='label_4_40_7' class='gform-field-label gform-field-label--type-inline'>(Optional) Any other information that you feel might be relevant (e.g. a brief description of any other special education, training or experience that might enhance your performance as an Eldercaring Coordinator)<\/label>\n\t\t\t\t\t\t\t<\/div><button type=\"button\" id=\"button_40_select_all\" class=\"gfield_choice_all_toggle gform-theme-button--size-sm\" onclick=\"gformToggleCheckboxes( this )\" data-checked=\"0\" data-label-select=\"Select All\" data-label-deselect=\"Deselect All\">Select All<\/button><\/div><\/div><\/fieldset><div id=\"field_4_45\" class=\"gfield gfield--type-fileupload 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field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_42\" ><h3 class=\"gsection_title\">ATTESTATION<\/h3><\/div><fieldset id=\"field_4_44\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_44\" ><legend class='gfield_label gform-field-label screen-reader-text gfield_label_before_complex' >I swear and affirm all of the following: that the information supplied on this application and all documents provided are correct; that to the best of my knowledge, I qualify for a position as Eldercaring Coordinator as defined by the Association for Conflict Resolution Guidelines for Eldercaring Coordination; and that I will notify, in writing, the Pilot Site in Adelaide. of any change in circumstance or condition stated in the application within 30 days of such event, including:  a) address change; b) legal name change; c) change in fees: d) any criminal conviction, or disqualifying event including any change in the status of a professional license or certification which I currently hold. I understand that any omissions, falsifications, misstatements or misrepresentations of the information provided in this application, or information required to be subsequently provided, may disqualify my eligibility to perform as eldercaring coordinator.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_consent'><input name='input_44.1' id='input_4_44_1' type='checkbox' value='1'  aria-describedby=\"gfield_consent_description_4_44\" aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_4_44_1' >By selecting this button, you attest to the following<\/label><input type='hidden' name='input_44.2' value='By selecting this button, you attest to the following' class='gform_hidden' \/><input type='hidden' name='input_44.3' value='2' class='gform_hidden' \/><\/div><div class='gfield_description gfield_consent_description' id='gfield_consent_description_4_44'>I swear and affirm all of the following: that the information supplied on this application and all documents provided are correct; that to the best of my knowledge, I qualify for a position as Eldercaring Coordinator as defined by the Association for Conflict Resolution Guidelines for Eldercaring Coordination; and that I will notify, in writing, the Pilot Site in Adelaide. of any change in circumstance or condition stated in the application within 30 days of such event, including:  a) address change; b) legal name change; c) change in fees: d) any criminal conviction, or disqualifying event including any change in the status of a professional license or certification which I currently hold. 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REGISTRATION: To register, submit both the Registration form and the Eldercaring Coordinator (EC) Application form (both available below). 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