Mediation Request Form
At Bloom High School  we strive to establish a culture of safety, respect, and inclusiveness. This form is used to request a mediation between students or groups of students. A mediation can be requested by either the student or the parents. A questionnaire is provided below.
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Who are the main people involved? *
Who are the other parties involved?
Describe the situation to the best of your knowledge. *
Please provide any additional information that may be helpful.
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This form was created inside of Bloom Township School District 206.

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