Request Mediation

Community members may request a mediation either by completing the form below, or by submitting a paper copy to the emotional supports or academic advising teams at their campus. Students are encouraged to reach out to staff for assistance in completing their request.

The form below can be used to anonymously request a mediation between Freire community members. All requests will be reviewed within 24 hours.

Mediation is a process in which trained mediators help individuals in a conflict (the disputants) to arrive at a peaceful resolution that meets everyone’s needs.

You can request a mediation for a conflict you are involved in, or you can request a mediation for other students who need help resolving a conflict. You can also request a mediation with a member of the Freire staff.

Fields marked with an * are required.

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What campus is this in reference to? * Please select… Freire Middle Freire High TECH Freire Freire Wilmington

Please briefly describe the nature of the conflict. *

Please name at least two people to participate in this mediation session. *

Disputant 1 Name *

Disputant 1 Role * Please select… Student Staff Parent Other

Disputant 2 Name *

Disputant 2 Role * Please select… Student Staff Parent Other

Disputant 3 (optional)

Disputant 3 Role Please select… Student Staff Parent Other

Disputant 4 (optional)

Disputant 4 Role Please select… Student Staff Parent Other

Please enter your name (optional — you may request mediation anonymously)

Please enter your phone number if you would like to be contacted (optional)

Submit Request