Follow the steps to fill out your Mediation Request Form.

1. Click the ‘Get Form’ button to access the mediation request form and open it in your preferred editing tool.
2. In Part I, provide your personal information as the person requesting voluntary mediation. Fill in your name, employee ID number, address, contact information, and job title. Be sure to indicate your work location and your program manager’s name along with their telephone number.
3. In the same section, classify your dispute by checking all applicable boxes related to the nature of your disagreement, such as age, communication issues, or workplace conditions.
4. Proceed to Part II where you will list the names and contact details of the individuals involved in the dispute, disagreement, or complaint. Provide information for up to three contact persons if necessary.
5. Part III requires you to briefly describe the incident that led to the dispute. Include what occurred and when it happened to provide context for your mediation request.
6. In Part IV, outline the steps you have taken to resolve the dispute. Additionally, include any attempts made by your program manager to resolve the situation and detail the resolution you are seeking.
7. Finally, acknowledge the confidentiality statement included in the form by signing and dating where indicated. This confirms your understanding of the mediation process.
8. After completing the form, ensure you save your changes. You may then download a copy, print it for your records, or share it as needed.

Begin filling out your Mediation Request Form online today to initiate the mediation process.