Prefix First Name * Last Name * Title/Certification Suffix Pronouns He/HimShe/Her Street State City Postal Country Email Office Phone Cell Phone Cell Phone My work in this field includes: TrainerFacilitatorCircle Keeper Other Describe how long you have been working in this field? Share a brief narrative describing your work and experience within this field: If you offer trainings, list a sample of trainings you offer: Beginner RPAdvanced RPRestorative ConferencingCirclesTrain the trainer Other I don't offer trainings Do you train under a specific model? If so, which: IRPSuffolk University Other I don't offer trainings Share testimonies/feedback from recent trainings: What other services do you provide? Restorative Justice ConferencingVictim/Offender DialogueCommunity Listening CirclesMediation Other What percentage of your time are you working with each of the following populations: -Schools (youth and/or staff): -Families -Professionals -Faith-based Institutions -Criminal Legal System -Juvenile Review Boards -Other: Do you offer responsive services that deal with conflict and/or harm? YesNo If yes, share some examples of the conflicts or harms you have worked with: Property DamageRacismNeighborhood DisputeFamily ConflictSexual HarrassmentWorkplace ConflictYouth Violence Other Share testimonies/feedback from recent responsive services: Is there anything else you would like us to know?
