Request Fee Assistance for Mediation

Name*

Phone Number*

Email or other secondary contact*

Postal Address

I am seeking assistance for mediation/training type

Select one

How much can you reasonably pay for this service ?*

Mediation typically costs Advoz between $600-1200 per session, so your contribution helps to cover the costs of coordinating these services for you and others in our community.

Will you be volunteering with Advoz over the next 12 months?

Yes
No

Please list the main factors impacting your ability to pay the full amount (income, debts, situation, etc.):*

Fee Assistance Request Form