Services > Request for Mandated Mediation
  



ACU Box 27770
Abilene, TX 79699
Phone: 325-674-2015

Application for Mandated AIM Services

Only ACU Officials are authorized to mandate student mediations.  Please complete the form below.

ACU Department making referral (Required)
ACU Official making referral (R)
ACU Official's phone number (R)
ACU Official's email (R)
Name of Student #1 mandated to mediation (R)
Name of Student #2 mandated to mediation (R)
Name of Student #3 mandated to mediation (if applicable) (R)
Briefly describe the nature of the conflict (R)
Briefly describe the relationship that exists between the referred students (R)
Please select one of the following time frames for the mediation (R)
Per the selected time frame, please state the exact date and start time for the mediation (e.g. Tuesday, August 1, 1:30 pm) (R)
Do you agree with the terms below? (R)

Note: Please do not include any URLs in form.

I recognize that although I am mandating the students' participation in mediation any settlement reached will be voluntary between and among the parties. The mediator is neither a judge nor an arbeter and has no authority to forces a settlement on parties. A settlement or agreement shall be reached in this case only if the parties agree in writing that the settlement or agreement is fair, in their best interest, and voluntarily undertaken. 

The mediator assigned to this case will be a volunteer graduate student, or staff person, who has met the educational and experience requirements of the AIM Program and the Center for Conflict Resolution. The mediator will have access to a supervisor who will provide advice and support for the mediator. Neither the mediator nor the supervisor will provided legal counsel or analysis of any party's legal rights in this case.

All information obtained in this case will be kept confidential unless: (1) all parties agree to release all or part of the information; (2) information regarding potential harm to persons and/or property are revealed; or (3) disclosure of information is required by law.  However, I understand that since I am referring students to mandated mediation I am entitled to know if the referred students attended the mediation.  Further, I understand that I will receive a copy of the students' mediation agreement. 

Mediation offered through the AIM Program and the Center for Conflict Resolution are free to students of Abilene Christian University.

I understand that the students will be provided with the information I have provided regarding the nature of the conflict.



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