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Mediation Request and Agreement Form - ksd140

Mediation Request and Agreement Form - ksd140 2026

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The document is a Peer Mediation Request & Agreement form designed for students to address and resolve conflicts with their peers. It includes sections for detailing the conflict, mediation details, and space for mediators to record proposed solutions. The form emphasizes collaboration between students and mediators to reach an agreement.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the date at the top of the form. This helps establish a timeline for your mediation request.
Fill in your name and room number in the designated fields. This information is crucial for identifying you within the school system.
In the section labeled 'Student/s you are having a conflict with', clearly list the names of those involved in the conflict. Be specific to ensure clarity.
Describe the conflict in detail in the provided space. Use clear language to convey your perspective, as this will aid mediators in understanding the situation.
Once completed, submit your request to your teacher as instructed at the bottom of the form.
During mediation, mediators will fill out their section, including ideas generated for resolving conflicts. Ensure all parties sign once an agreement is reached.

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