LEA Mediation Information Form Home LEA Mediation Information Form LEA Mediation Information Form LEA Mediation Information Form Please complete this form. The Mediation Case Manager will be in contact with you once you submit the form. Name* First Last Title Email* PhoneStudent Name* First Last Mediation File Number Please choose which format you prefer for your mediation session.online video conferencephone (audio-only)in-personMediation can be in-person*, through online video conferencing, or by phone. When mediation is not in-person, using video conferencing (example: Zoom) may help to improve communication. However, it is up to the parties to determine which format will work best for them. *Due to the COVID-19 pandemic, in-person mediation may not be available. Please provide multiple dates and times that you are available for the mediation. Dates should be at least a week or more in advance.Please write in the name, title, phone number, and email address of all participants you will be bringing to your mediation.To support a productive process, ODR suggests each party brings no more than three participants; however it is up to you to determine who will participate in the mediation. The names of your participants will be provided to the other party; the phone number and email address of participants will be provided to the mediator only, in case of technology issues during the mediation.