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CITY OF ORONO REFERRAL FORM <br />(TOi Community Mediation Services. Inc.^ <br />Referring/contactPerson:____________________Phone:__ <br />„ file# <br />CMS CASE NO: <br />n Human Relations <br />□ Police Department <br />□ Other <br />Fax: <br />□ City Council <br />□ City Staff <br />Are the parties aware of the referral to mediation? f Yes No <br />Have they agreed to mediate? C □ Yes 2 No <br />PEOPLE INVOLVED: <br />PARTY I:PARTY 2: <br />Name Name <br />Address Address <br />Phone <br />PARTY 3: <br />Phone <br />PARTY 4; <br />Name Name <br />Address Address <br />Phone Phone <br />TYPE OF DISPUTE:□ Merchant/Consumer □ Family <br />School□ Neighbor to Neighbor □ Human Rights <br />□ Property Issue □ Juvenile Offenders □ Harassmemt <br />□ Victim-Offender □ Other________ □ Landlord-tenant <br />Please use back of form for any additional parties and/or information. <br />MAIL TO: CommuBity McdiatioB Services, Inc. (formerly Nl IMP) <br />3300 County Road 10, Svitc 212, Brooklyn Center, MN 55429 <br />(763)561-0033 <br />FAX TO: (763)561-0266 <br />Police officers: Please iBcladt police report. <br />Providing of^rtmitles to resolve conflicts effectively ami respect fully <br />Revised 8 04 <br />Kfiaai&i