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Tilden & Umoja Peace Room Services
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* Indicates required question
Name, Role
*
Your answer
Email Address
*
Your answer
Case Type
*
Check one to indicate service requested
Reactive RJ (i.e. Peace Circle, Restorative Conversation, Staff-Student Mediation etc.)
Proactive RJ (i.e. Community Building, Celebration Circle, Talking Circle)
Thought-Partnership (re: RJ Integration in professional role, curriculum, etc)
Case Description
*
Describe context, people involved, desired outcome.
Your answer
Caes Urgency
*
How time-sensitive is this case?
Today--Case is very urgent
This Week--Case is pressing, but not urgent
On Your Radar--Would like to connect soon about case
Available Periods to Meet w/ PR Staff
*
Check ALL that apply (i.e. Prep Periods, free time before or after school)
AM--Before School
Period 1
Period 2
Period 3A
Period 3B
Period 4
PM-- After School
Other:
When Would You Like to Schedule Your Intervention?
( Day, Period, and How Long?)
Your answer
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