Prefix First Name * Last Name * Title/Certification Suffix Pronouns He/HimShe/Her Street State State Postal Country Email Office Phone Cell Phone What communities you serve? TownsCountiesStatewide What population/target audience do you serve AdultsYouthFamiliesProfessionalsOther Years of Training Areas of Expertise BIPOCLGBTQIA+ImmigrantRightsDisabilityRightsOther Successes/Testimonials What other services do you provide? Restorative Justice ConferencingVictim/Offender DialogueCommunity Listening CirclesMediationOther What types of trainings do you provide? (If you do not train, skip next two questions) Beginner RPAdvanced RPRestorative ConferencingCirclesTrain the trainerI dont provide trainingOther What types of harms or conflicts have you worked with? Property DamageRacismNeighborhood DisputeFamily ConflictSexual HarrassmentWorkplace ConflictYouth ViolenceOther What model do you train under? (Click all that apply) IRPSuffolk UniversityOther
