Conflict-Mediation-Form

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Liberty University *

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660

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Information Systems

Date

Oct 30, 2023

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2

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GENERAL SMALLWOOD MIDDLE SCHOOL CONFLICT MEDIATION REPORT FORM Conflict Mediators: __________________________________ Date: ____________ ___________________________________ Start Time: _____________ End Time : _____________ Who had the conflict: _________________________________ Grade: __________ _________________________________ Grade: __________ What kind of conflict: _______ Argument Is this an Emergency?: ________ Rumor _____ Yes ______ No ________ Fight ________ Other ______________________________________ Referred by (name): _____________________________________________________ (check one) ________ Administrator _________ Teacher ________ Counselor _________ Student What was the conflict about: _____________________________________________ _______________________________________________________________________ _______________________________________________________________________ Was the conflict resolved? ________ Yes ________ No Resolution: Student #1: Student #2: Name: __________________________ Agrees to: _______________________ _________________________________ _________________________________ _________________________________ _________________________________ [Grab your reader’s attention with a great quote from the document or use this space
GENERAL SMALLWOOD MIDDLE SCHOOL CONFLICT MEDIATION REPORT FORM _________________________________ _________________________________ _________________________________ STUDENT SIGNATURE Name: __________________________ Agrees to: _______________________ _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ STUDENT SIGNATURE [Grab your reader’s attention with a great quote from the document or use this space
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