Ombuds Mediation Request

(All contents will remain confidential)

Please fill out the form below. Your request will be reviewed by the Ombuds and Faculty Mediators Committee, and if found to be appropriate for mediation, you will be assigned a primary and a secondary mediator. The primary mediator will contact both parties to determine if both parties are willing to participate in mediation. If both parties are willing, the mediator will make arrangements for a mediation session. Neither mediator will be from the college(s) in which the parties work.

For further information about your request, please contact Dr. Kristin Gansle, University Faculty Ombuds: ombuds@odu.edu. She will contact you shortly to discuss your concerns.
Name Name * First Last
Email *
Position at ODU
Phone Phone - ### - ### ####
College/Department *
I would like remediation for a concern with:
Respondent Name Respondent Name First Last
Respondent Email
Respondent Phone Respondent Phone - ### - ### ####
Please briefly state the issue you want mediated; please do so in no more than 500 words. *
Please briefly list all prior attempts you made to resolve the matter. These might include meeting with the respondent, phone conversations, email communications, and so on. Please do so in no more than 500 words.