Peer Conflict Mediation Referral
This form is to give the basic information about the conflict. We understand that it is often complicated and doesn't fit into this form. However, we always check in individually with people, so we are mainly interested in basic details.

This form goes directly to Peer Resources, not the Deans or Counselors. Mediations are done by trained Lincoln students, with the support of Morgan Wallace, Peer Resources teacher. It will remain confidential, unless there is a safety issue involved (someone is going to hurt themselves, someone else, or they are being hurt). Once we receive it, we check in with the people involved and set a time for doing the mediation.

1. Your Name (First and Last)
This can remain confidential if you wish.
Your answer
Who is involved?
In order to help you solve the conflict, we need to know who is involved. Please add the two most important people below, using their official names. If there are more than two, just include them in the description section below.
2a. First Person Involved in Conflict (First and Last) *
One of the people who is having a conflict. If you are referring a conflict of your own, this is you.
Your answer
2b. Person One is a.....
3a. Second Person Involved in Conflict (First and Last) *
Other person involved in the conflict.
Your answer
3b. Person Two is a.....
4. Type of Conflict *
5. What happened? *
We will be checking in personally for more detail, but please give us a brief description of the conflict.
Your answer
6. Urgency *
How urgent is this issue?
7. When is the best time for a mediator to check in with you about this conflict? *
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