United States Department of Health and Human Services
DEPARTMENTAL APPEALS BOARD
Alternative Dispute Resolution (ADR) Division
Thank you for expressing interest in an ADR training course. To register for a course, complete
this form and submit it to ADR@hhs.gov.
If the course you register for is full, you will be wait-listed. You will be notified only when you are
selected (not wait-listed) for a course.
*Required to fill
Name* Date*
Agency* Position Title*
E-mail* Phone*
Select the course you would like to register
Have you received approval from your
supervisor to attend this course?*
for*
Basic Mediation Skills
Yes No
Conflict Management Skills
Advanced Mediation Skills
Negotiation Skills
T
ransformative Mediation Skills
Have you taken this course before?*
Yes No
If yes, when did
you take it? (Month/Year)*
Please list the date of the course you are interested in and your reason for taking this course?*
