Request for Mediation

By requesting mediation I understand:

The mediator is not providing any party with legal advice or understanding.
The mediator is not providing counseling or therapy services.
The mediation process may involve the mediator speaking privately to the parents and the school representatives.
The mediator will work with all of the parties to help develop an agreement.
Discussions during the mediation session will be confidential and may not be used during subsequent proceedings.
I may not call the mediator as a witness in any further proceeding pertaining to the child’s case.
The signed agreement may be shared with other educators working with the child.

Name of person requesting mediation(Required)

First Last

Address(Required)

Street Address City State ZIP Code

Phone(Required)

Second phone

Is there any pending litigation in this case?(Required)

Yes

Upload the documents from the pending litigation.

Accepted file types: pdf, jpg, png, Max. file size: 49 MB.

Do you have an attorney?

Yes

If your answer is Yes, then fill out the next two questions, please. An attorney is not required to obtain mediation assistance.

Attorney's name

First Last

Attorney's phone number

Summary of issues to be discussed in mediation(Required)

Other party in the case(Required)

First Last

Address

Street Address City State ZIP Code

Phone(Required)

Second phone

Does the other party in the case have an attorney?

Yes

I don't know

If your answer is Yes, then fill out the next two questions, please. An attorney is not required to obtain mediation assistance.

Attorney's name

First Last

Attorney's phone number

How did you hear about us?

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