Mediation Services

UMKC Campus Mediation Services - CMS Referral Form


1. Name of the referring party:
2. Role or position of referring party:
3. Contact information for the referring party:
4. Date and time referral requested:
5. Nature of the conflict being referred:
6. Contact information for people involved in the conflict, include both phone and e-mail and best time to contact parties, if known:
     First party:
     Second party:
7. Do parties involved know that referral is being made?
8. Other methods used to resolve conflict:
9. Level of urgency:
10. Other important information:
 
 
 
Type the code words that appear below in the box below. These values are case sensitive.