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Peer Mediation

Application for 2016-2017


Booker Middle School is looking for students with the following qualities to trai n as peer mediators for
the 2016-2017 school year:
A desire to help others resolve disagreements
The ability to be an effective listener
Acceptance by peer and/or perceived by teachers to be leaders
Ability to independently coordinate makeup work due if classes
occasionally missed
Name: _________________________________

Current Grade:

Email: _______________@_________________
Describe examples of conflicts you have seen at school?
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
What could you do (or have done in the past) to assist other students involved in a conflict?
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
If selected, candidates attend a mandatory training on Mondays and Fridays, beginning, Sept. 26th thru
Oct. 14th. The trainings will be during encore classes or lunch. Due to the amount of content covered,
students will receive some homework, which is expected to be completed for successful training. All
applicants must obtain at least 2 recommendations from school teachers or staff members.
Recommendations should be requested and forms distributed no later than September 13th. Please
provide the names of the faculty/staff that you have distributed your recommendation forms to:
1.__________________________ 2.___________________________
_______________________________________
Student Signature
Date

_______________________________________
Parent Signature
Date

Applications are due to Booker Middle Schools Counseling Office no later than Monday, September
19th in order to notify the selected candidates prior to the mandatory training. Applications will be
accepted by mail, hand delivered, scanned and emailed: Cheryl.thomas@sarasotacountyschools.net, or
faxed: 941-359-5898. Applicants will be notified no later than Wednesday, September 21st.

This section to be completed by applicant:

Applicants Name: ___________________________

Grade: ________

Peer Mediation
Faculty/Staff Recommendation form 2016-2017
Booker Middle School is looking for students with the following qualities to train as pe er mediators for
the 2016-2017 school year:
o
o

A desire to help others resolve disagreements


The ability to be an effective listener

o Accepted by peer and/or perceived by teachers to be leaders


o Able to independently coordinate makeup work due to missed class while
mediating (Occasionally)
Faculty/Staff Name: _______________________________
In what capacity do you know this candidate? ____________________________________
_________________________________________________________________________________
Compared to his/her peers, please rate this candidate in the following areas:
Poor Marginal
Unsure
Fair
Superior
Responsibility
Cooperation
Leadership
Follow Through
Trustworthiness
Emotional Maturity
Empathy
Fairness

Integrity (Optional) Additional information we should know about this


candidate_______________________
__________________________________________________________________________ _______
_________________________________________________________________________________
_________________________________________________________________________________
Teac hers: when completed please return to Mrs. Thomas or Mrs. Clark no later than Monday,
September 19
th

This section to be completed by applicant:

Applicants Name: ___________________________

Grade: ________

Peer Mediation
Faculty/Staff Recommendation form 2016-2017
Booker Middle School is looking for students with the following qualities to train as peer mediators for
the 2016-2017 school year:
o
o

A desire to help others resolve disagreements


The ability to be an effective listener

o Accepted by peer and/or perceived by teachers to be leaders


o Able to independently coordinate makeup work due to missed class while
mediating (Occasionally)
Faculty/Staff Name: _______________________________
In what capacity do you know this candidate? ____________________________________
_________________________________________________________________________________
Compared to his/her peers, please rate this candidate in the following areas:
Poor Marginal
Unsure
Fair
Superior
Responsibility
Cooperation
Leadership
Follow Through
Trustworthiness
Emotional Maturity
Empathy
Fairness

Integrity (Optional) Additional information we should know about this


candidate_______________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Teac hers: when completed please return to Mrs. Thomas or Mrs. Clark no later than Monday,
September 19th

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