Dave Hileman

115 W. Locust

P.O. Box 71

Union, MO63084

(314) 583-5141

Teacher Post Survey

To: Peer Conflict Mediator Advisors

Re: Request for Information

Dear Advisor,

I am seeking your help to determine the impact of the Peer Conflict Mediation programs that I have been associated with. Please complete the information at the bottom of this form and return it to me as soon as possible. Your help will be greatly appreciated.

Also, enclosed you will find an evaluation form for your mediators to complete. If you feel that it is appropriate, and if you have the opportunity, please have as many of your mediators as possible complete the form. I suggest you copy your student's completed forms for your own information, and then return them to me. Again, I appreciate your efforts to help me evaluate this program.

Sincerely,

Dave Hileman

4-H Youth Development Specialist.

How many mediators did you have this year?MalesFemales

How many mediations were held in your school?

How many successful mediations were held?

What did you like about the training your mediators received?

How could the training be improved?

On the back, briefly describe the impact you feel Peer Conflict Mediation has had on your school.

Student Post Survey

To: Peer Conflict Mediators

Re: Evaluation of Peer Conflict Mediation Training

Dear Student,

Thank you for your efforts as a Peer Conflict Mediator for your school. It seems so long ago that I had the opportunity to spend some time with you during Peer Conflict Mediation Training.

Attached is a short evaluation form that I am asking you to complete. The information you give me will be used to evaluate the training effort so that improvements can be made where needed. The information will also be used to see how life as a peer conflict mediator affects young people as a student and a person.

I hope you will take the time to complete the survey and return it to your Peer Mediation Advisor.

Sincerely,

Dave Hileman

4-H Youth Specialist

PEER CONFLICT MEDIATION SURVEY

School:

Personal Information:

Grade:Number of years as a mediator:

Gender:MaleFemaleAge:

Number of mediations you helped conduct this year:

Number of successful mediations you helped conduct this year:

Have you helped mediate any conflicts informally (at home, between friends, etc.)?YesNo

If yes, how many times?

Circle the number on the line that best indicates your feelings about the following:

How would you rate your peer mediation training?

12345678910

CompletelyVerySomewhatNot

EffectiveEffectiveEffectiveEffective

How prepared were you to mediate conflicts at the end of the training?

12345678910

VerySomewhatA LittleNot

PreparedPreparedPreparedPrepared

Please give any suggestions you have for improving the training:

How do you think other students feel about Peer Conflict Mediators?

12345678910

Very SomewhatA littleVery

PositivePositiveNegativeNegative

Comments:

What are you proud of as a peer mediator?

What are your concerns about being a peer mediator?

Has your involvement as a peer mediator affected or changed you personally? How?

What has been your most positive experience as a peer mediator?

What has been your most negative experience as a peer mediator?

How will your experience as a peer mediator affect your life as an adult?

Other comments: