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Columbia University Mediation Clinic Referral: Follow Up

Following a mediation between two (or more) undergraduate Columbia College/School of Engineering and Applied Science students, please submit the following information. The information provided below helps the Residential Programs staff to continue to support students throughout their on-campus experience at Columbia University. This information will be forwarded to the appropriate staff for follow up and documentation in the Maxient incident management system.

Please list all students (last, first), including their UNI, involved in this conflict:

Please briefly describe the mediation outcome:

Residence Hall from where the conflict was referred:

Please Scan and Upload the Resident Agreement Form in PDF format.

Files must be less than 2 MB.
Allowed file types: jpg jpeg png pdf.

Statement of Understanding

Yes

I understand that mediation is a voluntary process. I also understand that it is confidential, with limited exceptions (e.g. credible threats of imminent harm) that will be fully reviewed prior to the mediation.

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Columbia University Mediation Clinic Referral: Follow Up

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