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  • Peer Mediation Request Form

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    Peer mediation requests are processed at the end of each school day. You will receive notification of your request the following day. A mediation session requires 24 hour notice for Peer Mediators. All mediation sessions take place after school. Your requests will remain confidential unless disciplinary action is required.

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    Peer mediation requests are processed at the end of each school day. You will receive notification of your request the following day. A mediation session requires 24 hour notice for Peer Mediators. All mediation sessions take place after school. Your requests will remain confidential unless disciplinary action is required.

    Drepturi de autor:

    © All Rights Reserved
    Descărcați ca DOCX, PDF, TXT sau citiți online pe Scribd
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    57 vizualizări1 pagină

    Peer Mediation Request Form

    Încărcat de

    api-314325235
    Peer mediation requests are processed at the end of each school day. You will receive notification of your request the following day. A mediation session requires 24 hour notice for Peer Mediators. All mediation sessions take place after school. Your requests will remain confidential unless disciplinary action is required.

    Drepturi de autor:

    © All Rights Reserved
    Descărcați ca DOCX, PDF, TXT sau citiți online pe Scribd
    Indicator pentru conținut neadecvat
    din 1

    Peer Mediation Request Form

    Peer Mediation Requests are processed at the end of each school day. You will receive notification of your request the following day. A mediation
    session requires 24 hour notice for Peer Mediators. All mediation sessions take place after school. Your requests will remain confidential unless
    disciplinary action is required.

    Name of Person Requesting: _______________________________________________ Date: __________________________


    Others Involved: ____ Friend ____Classmate

    ____Sibling ____ Staff Member

    Name(s) of People Involved: ________________________________________________________________________________


    _________________________________________________________________________________________________________
    Reason You Are Requesting Peer Mediation: ___________________________________________________________________
    __________________________________________________________________________________________________________
    __________________________________________________________________________________________________________
    Signature: __________________________________________________________________ Date: ________________________
    For Office Use Only:
    Date Evaluated: ________________________
    Mediators Requested: __________________________
    Accepted for Mediation: ____ Yes ____ No
    __________________________
    Date/Time for Mediation: _________________________________________________________________________________
    Signature of Coordinator: _________________________________________________________________________________
    Notes:

    Peer Mediation Request Form


    Peer Mediation Requests are processed at the end of each school day. You will receive notification of your request the following day. A mediation
    session requires 24 hour notice for Peer Mediators. All mediation sessions take place after school. Your requests will remain confidential unless
    disciplinary action is required.

    Name of Person Requesting: _______________________________________________ Date: __________________________


    Others Involved: ____ Friend ____Classmate

    ____Sibling ____ Staff Member

    Name(s) of People Involved: ________________________________________________________________________________


    _________________________________________________________________________________________________________
    Reason You Are Requesting Peer Mediation: ___________________________________________________________________
    __________________________________________________________________________________________________________
    __________________________________________________________________________________________________________
    Signature: __________________________________________________________________ Date: ________________________
    For Office Use Only:
    Date Evaluated: ________________________
    Mediators Requested: __________________________
    Accepted for Mediation: ____ Yes ____ No
    __________________________
    Date/Time for Mediation: _________________________________________________________________________________
    Signature of Coordinator: _________________________________________________________________________________
    Notes:

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