JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Mediation Sign-Up
Please provide us with the following information so that we assign you a mediator as promptly as possible.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Your Name
Your answer
Your Mailing Address
Your answer
Your Phone Number
Your answer
Please describe the days and times you can be available for mediation.
Your answer
Name and contact info for other parties. (Please include at least an email or phone number for each of them.)
Your answer
Has the other party agreed to mediation
*
Yes
No
Required
Please write a brief description of the conflict you wish for us to mediate.
Your answer
My conflict involves:
(All fees are administered on a sliding scale. We do not turn away clients for inability to pay.)
Small Claims Court (no fee)
Domestic dispute (sliding scale)
Individual dispute--i.e., landlord/tenant, neighbors, relationships, workplace etc. (sliding scale)
My business or organization (sliding fee)
Ohio University (no fee if within contracted services)
Other:
Clear selection
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
