Request a Mediation
If you are in a conflict and interested in mediation services, call us at 612-822-9883 or use the Request a Mediation online form.
Your Name
(Required)
Your Company Name (If relevant)
Your Email (type "N/A" if you do not have an Email)
(R)
Your Phone
(R)
Do you plan to participate in the services you are requesting or are you referring others?
No, I am referring others
Yes, I plan to participate
(R)
Another Participant's Name
Another Participant's Company Name (If relevant)
Another Participant's Email (type "I don't have it" if needed
Another Participant's Phone (type "I don't have it" if needed)
What type of dispute is it regarding?
- Select -
Business / Consumer
Business / Business
Family: Elder
Family: Property
Family: Shared-Parenting
Family: Other
Housing: Habitability
Housing: Property Line
Housing: Neighbor Harassment
Housing: Noise
Housing: Rent / Utility Assistance
Housing: Tenant Conduct
Housing: Tenant Conflict
Housing: Other
Workplace: Conduct
Workplace: Other
Workplace: Employee Conflict
Workplace: Large Group
Friendship
(R)
Please describe the matter(s) you would like to discuss. (What is your conflict? Who is it with? What should we know?)
(R)
What is the relationship between the participants?
- Select -
unknown
Buyer - Seller/Agent
Citizen - Government
Client - Agency
Co-Workers
Consumer - Merchant
Debtor - Colletions Agent
Divorced
Employer - Employee
Ex-Romantic Partners (never married)
Extended Family
Friends
Guardian - Ward
Home Owner Assoc - Owner
Immediate Family
Landlord - Tenant
Married
Neighbors
Never-Married Parents
Current Romantic Partners
Roommates/Housemates
School - Student/Parent/Guardian
Strangers
Student - Staff
Student - Student
Restorative Justice Conferencing
Youth - Parent/Guardian
Other
(R)
Is there an upcoming court date related to this issue?
mm/dd/yy
How did you find out about CRC and mediation?
(R)
What is your gender? (Demographic information helps us as a non-profit to improve our services.)
- Select -
Female
Male
Non-Binary
Transgender Female
Transgender Male
Not Reported
What is your Race or Ethnicity?
American Indian or Alaska Native
Asian
Black or African American
Latinx
Native Hawaiian or Other Pacific Islander
White
Multi-Racial
Other
Decline or Not Reported
What is your age?
What county in Minnesota do you live in?
- Select -
Aitkin
Anoka
Becker
Beltrami
Benton
Big Stone
Blue Earth
Brown
Carlton
Carver
Cass
Chippewa
Chisago
Clay
Clearwater
Cook
Cottonwood
Crow Wing
Dakota
Dodge
Douglas
Faribault
Fillmore
Freeborn
Goodhue
Grant
Hennepin
Houston
Hubbard
Isanti
Itasca
Jackson
Kanabec
Kandiyohi
Kittson
Koochiching
Lac qui Parle
Lake
Lake of the Woods
Le Sueur
Lincoln
Lyon
Mahnomen
Marshall
Martin
McLeod
Meeker
Mille Lacs
Morrison
Mower
Murray
Nicollet
Nobles
Norman
Olmsted
Otter Tail
Pennington
Pine
Pipestone
Polk
Pope
Ramsey
Red Lake
Redwood
Renville
Rice
Rock
Roseau
Scott
Sherburne
Sibley
Stevens
Swift
St. Louis
Stearns
Todd
Traverse
Steele
Wabasha
Wadena
Waseca
Washington
Watonwan
Wilkin
Winona
Wright
Yellow Medicine
Not Reported
Outside Minnesota
How many people are in your household?
- Select -
1
2
3
4
5
6
7
8
9
10
Not Reported
11+
What is your primary employment status?
- Select -
Disability
Employed
Family Member Employed
Public Assistance
Social Security/Retired
Student
Unemployment
Unknown
What is your highest level of education?
- Select -
Some High School
Completed High School
Some College/Trade School
Completed College/Trade School
Post Graduate
What is your approximate annual household income?
Note: Please do not include any URLs in form.
Conflict Resolution Center is a 501(c)3 nonprofit organization.