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IL Kirby School District Peer Mediation free printable template

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Peer Mediation Request & Agreement Date: Name: Room #: Student/s you are having a conflict with: Describe the conflict: Do NOT write below this line! Give Mediation Request to your teacher. Portion
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How to fill out IL Kirby School District Peer Mediation Request

01
Obtain the IL Kirby School District Peer Mediation Request form from the school or their website.
02
Fill in the date at the top of the form.
03
Provide your full name and grade level in the designated fields.
04
Include the name and grade level of the other party involved in the conflict.
05
Describe the issue briefly in the space provided, focusing on the main points of contention.
06
Indicate any attempts you have made to resolve the issue before requesting mediation.
07
Sign and date the form to confirm your request.
08
Submit the completed form to the designated school official or peer mediation coordinator.

Who needs IL Kirby School District Peer Mediation Request?

01
Students who are experiencing conflicts with peers and wish to resolve issues in a constructive manner.
02
Parents or guardians of students seeking mediation assistance for their child.
03
Teachers or school staff who recognize conflicts among students and suggest mediation.
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The IL Kirby School District Peer Mediation Request is a formal process used by students to request mediation services to resolve conflicts or disputes with their peers through guided discussion and support.
Any student who feels they are involved in a conflict with another student and wishes to seek resolution through peer mediation is encouraged to file the IL Kirby School District Peer Mediation Request.
To fill out the IL Kirby School District Peer Mediation Request, students should provide their personal information, a description of the conflict, names of the parties involved, and any other relevant details needed for the mediation process.
The purpose of the IL Kirby School District Peer Mediation Request is to facilitate conflict resolution among students in a safe environment, promoting understanding and communication while helping to restore relationships.
The IL Kirby School District Peer Mediation Request must include the student's name, grade, details of the conflict, parties involved, and any specific concerns that need to be addressed during mediation.
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