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Peer Mediation Contract
Date__________________________
Peer mediators
Speaker______________________________________________________ Recorder_____________________________________________________
Students involved
Student #1 Name__________________________________ Grade_______ Teacher_____________________ Student #2 Name__________________________________ Grade_______ Teacher_____________________
Problem
The two students listed above came to peer mediation for a problem dealing with ________________________ _________________________________________________________________________________________.
Solution
The two students agreed that a good solution would be _____________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________
Agreement
The two students agreed that they will do the following if this happens again ____________________________ __________________________________________________________________________________________
Student #1 Signature___________________________
Student #2 Signature__________________________