REQUEST FOR SPECIAL EDUCATION MEDIATION

Wisconsin Special Education Mediation System (WSEMS)

INSTRUCTIONS: Complete and submit one (1) signed copy. Retain a copy for your records. Submit signed form to:

WISCONSIN SPECIAL EDUCATION MEDIATION SYSTEM
Gia Pionek
PO BOX 70693
Milwaukee, WI 53207

Email: gia@wsems.us
Website: wsems.us

 

1. Either the parent or school district may initiate the mediation process by completing this Request for Special Education Mediation form and sending the completed form to the WSEMS.

2. Both the parents and school district administrator may jointly complete a single Request for Special Education Mediation form. The form should be mailed or emailed to the WSEMS at the address or phone number shown. The WSEMS will arrange mediation at a location, date, and time convenient to both parties.

3. If a non-joint request, the WSEMS will notify the other party in writing of the request for mediation with a request that the other party notify WSEMS within five (5) business days after receiving the notice of their willingness to participate in mediation. If the responding party agrees to mediate, WSEMS will appoint a qualified mediator to arrange a mediation session. If the WSEMS does not receive a timely response or if the other party notifies the WSEMS of their refusal to participate in mediation, the WSEMS will so notify the requesting party.

We understand mediation is a voluntary dispute resolution option available to encourage early resolution of issues whenever possible. We understand that mediation may not delay or deny the right to a due process hearing or IDEA complaint. We understand that mediation is confidential and that the information will not be shared with others. We understand that signing this request gives the WSEMS mediator, Intake Coordinator, and System Administrator access to information about the student, including information from the IEP document, disability information, and school day schedule.

Signature of School District Administrator or Designee

Signature of a Parent/Guardian/Adult Student

10/4/21 The Wisconsin Special Education Mediation System (WSEMS), CFDA #84.027A, acknowledges the support of the Wisconsin Department of Public Instruction in the development of the system and for the continued support of this federally-funded grant project. There are no copyright restrictions on this document; however, please credit the Wisconsin DPI and support of federal funds when copying all or part of this material.