Get the free Peer mediation referral - St. Paul Catholic Church

PEER MEDIATION REFERRAL Students Involved in Conflict: Grade: Grade: Person Making Referral: Self referral Teacher Principal×Staff Name: Date of Incident: Date of Referral: Brief Explanation of Conflict:

How to fill out peer mediation referral

How to fill out a peer mediation referral:

1. Start by obtaining a peer mediation referral form. These forms are typically available from a school counselor or administrator.
2. Fill out the student information section of the form. Provide the student's name, grade level, contact information, and any other relevant details requested.
3. Identify the reason for the referral. Indicate the specific issue or conflict that requires peer mediation. Be as detailed as possible in describing the situation so that the mediators have a clear understanding of what they will be addressing.
4. Determine the desired outcome. Consider what you hope to achieve through peer mediation and state it clearly on the form.
5. Identify any individuals involved in the conflict or dispute. Provide the names and any other identifying information of all parties involved.
6. Attach any supporting documentation or evidence. If there are any relevant documents, notes, or messages related to the conflict, include copies with the referral form.
7. Seek the necessary signatures. Both the student seeking mediation and a parent or guardian may need to sign the referral form, depending on the school's policy.
8. Submit the completed referral form to the designated person or office. Follow any instructions provided to ensure that your referral is processed promptly.

Who needs a peer mediation referral:

1. Students involved in conflicts or disputes with their peers may need a peer mediation referral.
2. Peer mediation referrals are typically used when the conflict is not severe enough to warrant intervention from a teacher or administrator, but still requires assistance in finding a resolution.
3. Students who want to resolve their issues through open communication, understanding, and compromise can benefit from peer mediation referrals. It provides them with an opportunity to have their voices heard and work towards a mutually agreeable solution.

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What is peer mediation referral?

Peer mediation referral is a process in which students refer their peers to mediation to resolve conflicts.

Who is required to file peer mediation referral?

Typically, teachers, counselors, or administrators are required to file peer mediation referrals.

How to fill out peer mediation referral?

To fill out a peer mediation referral, one must provide information about the students involved, the nature of the conflict, and any relevant background information.

What is the purpose of peer mediation referral?

The purpose of peer mediation referral is to help students resolve conflicts in a peaceful and constructive manner.

What information must be reported on peer mediation referral?

Information such as the names of the students involved, details of the conflict, and any previous attempts to resolve the issue should be reported on a peer mediation referral.