Mediation in Special Education
in Washington State
Parents and School Systems Working Together

 

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State of Washington
Special Education Mediation
MEDIATION AGREEMENT

Name of Student: _____________________	School District: _____________________
Date of Mediation: _____________________	Case No.: _____________________

PARTIES:

_________________________________	_________________________________
Parent/Guardian	School District Representative

Additional Participants to the Mediation: include relationship to student)

_________________________________	_________________________________
_________________________________	_________________________________
_________________________________	_________________________________
_________________________________	_________________________________
_________________________________	_________________________________

TERMS OF AGREEMENT
(Use additional pages if necessary)

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_________________________________	_________________________________
Parent/Guardian Signature	School District Representative Signature

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This information is in the public domain and can be freely copied and used in trainings as handouts at parent and community meetings, and in creating your school or district programs. (Please cite all sources of materials you use.)

This information is provided by:
Office of State Superintendent of Public Instruction
Special Education
P O Box 47200
Olympia, WA 98504-7200
(360) 725-6088
Fax (360)586-1631
E-mail: dgill@ospi.wednet.edu