Evaluation: Mediation

Mediation Evaluation

Please fill out the form below.

* indicates a required field

Mediation Session Date.:

LEA (Local Education Agency):

Name of Mediator:

1) Please identify your role:

2) Please rate your overall experience with mediation, with 5 being poor, and 1 being excellent.
Services provided by ODR:

Additional Comments.

3) Please rate your overall experience with the mediator, with 5 being poor, and 1 being excellent.
Services provided by ODR:

Additional Comments.

4) Please rate your overall experience with the coordination services provided by ODR, with 5 being poor, and 1 being excellent.
Services provided by ODR:

Additional Comments.

Do you have suggestions for improving the mediation services provided by ODR?

If you would like ODR to contact you about this evaluation, please provide the following:

Name:

Telephone number(s):

Best time to call:

Thank you for providing feedback to ODR regarding medition