2019-2020 Peer Mediation/Circle Request
Iao School has a Peer Restorative Practices Program that can help students problem-solve issues at school. Participation is voluntary, unless directed by Admin. Information will be kept private. Mrs. Van Kleef and her Peer Communication students would like to help Iao School be the BEST it can be.
Please complete this form and Mrs. Van Kleef will schedule the Peer Mediation, or Restorative Circle.
Restorative Practice Type
How would you describe this issue:
If it is not listed, pick the closest to your choice, or describe it as OTHER. You may select more than one.
Boy/Girl or Girl/Boy drama
Hitting/Fighting/unwanted physical contact
Peer Pressure to do something you don't want to/Want you to change
Your name (first and last)
People involved (first and last names would be helpful)
Where did the conflict/disagreement occur?
Briefly describe the problem:
Send me a copy of my responses.
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This form was created inside of Iao Intermediate School.