An applicant for renewal of certification shall submit the following materials to support the application:

1. (a) An agenda as described in Fam 604.05(e) if there have been any changes in the program since the agenda was last submitted to the board;
2. (b) A separate strategy sheet as described in Fam 604.05(f) for each of the types of knowledge and skills listed in Fam 604.04 if there have been revisions in strategy since such sheets were last submitted to the board;
3. (c) For all role-play scenarios used by the program which have been revised since the relevant information was last submitted to the board, a statement describing how each is incorporated into the training agenda and program schedule;
4. (d) The student manual described in Fam 604.07 if it has been revised since it was last submitted to the board;

5. (e) For the director, if the director has changed since the information was last submitted to the board, and for each trainer not previously identified to the board, the following information, as applicable, on a “Staff Information: Trainer” form, a “Staff Information: NH Law Specialist” form or a “Staff Information: Domestic Violence Specialist” form:

   1. (1) His or her family mediator certification number; and

   2. (2) A statement describing:

      1. a. Which portions of the training he or she will present; and
      2. b. His or her qualifications to present such portions;

6. (f) To show completion of the continuing education required by Fam 604.09(d) and Fam 604.10(d), a certificate issued by the course provider for each course taken by the director and each course taken by each trainer, showing:

   1. (1) The name of the course provider;
   2. (2) Whether participation was through attendance at a live presentation;
   3. (3) The topic(s) covered by the course; and
   4. (4) The date and number of hours of the course;

7. (g) For the director, if the director has changed since the information was last submitted to the board, the following information on a “Staff Information: Director” form:

   1. (1) Documentation of the 50 hours of experience as a presenter required by Fam 604.09(b) in the form of:

      1. a. The brochure(s) describing the workshop(s), seminar(s), or course(s) at which presentations were made;

      2. b. One or more certificates issued by the event provider(s) showing:

         1. 1. The name of the provider(s) of the event(s);
         2. 2. Whether the presentation(s) was live or otherwise;
         3. 3. The topic(s) covered; and
         4. 4. The date and number of hours of the event(s); and
      3. c. The evaluation forms completed to show the students' evaluations of the event(s) and the presenter; and

   2. (2) Documentation of the 350 hours of face-to-face mediation in at least 30 family cases required by Fam 604.09(c) in the form of a list of the family cases with the names redacted, showing for each case:

      1. a. Its starting and ending dates;
      2. b. The type of case; and
      3. c. The total number of hours expended;

8. (h) For each member of the training staff whose information has not yet been submitted to the board:

   1. (1) Documentation of the 50 hours of experience as a presenter required by Fam 604.10(b) in the form of:

      1. a. At least 10 evaluation forms completed by those taking the 40-hour core mediation training; or
      2. b. At least 20 evaluation forms completed by those attending the continuing education presentations; and

   2. (2) Documentation of at least 250 hours of face-to-face mediation in at least 20 family cases within the last 3 years required by Fam 604.10(c), in the form of a list of the family cases with the names redacted, showing for each case:

      1. a. Its starting and ending dates;
      2. b. The type of case; and
      3. c. The total number of hours expended; and

9. (i) For the director, if the director has changed since the information was last submitted to the board, and any trainer whose information has not yet been submitted to the board and who presents 20 or more hours of the basic course described in Fam 604.02, documentation of completion of the continuing education requirements stated in Fam 703, in the form of:

   1. (1) Transcripts issued by the course provider(s); or

   2. (2) Certificates issued by the course provider(s) for each course taken, showing:

      1. a. The name of the course provider;
      2. b. Whether participation was through attendance at a live presentation;
      3. c. The topic(s) covered by the course; and
      4. d. The date and number of hours of the course.

Source. #9156, eff 5-10-08; ss by #9676, eff 4-2-10; ss by #12507, INTERIM, eff 4-2-18, EXPIRED: 10-1-18 New. #12638, eff 10-2-18