U.S. Equal Employment Opportunity Commission
This is a sample Agreement to Mediate from the U.S. Department of Air Force
1. I have received the mediation memorandum from [name of mediator] confirming my agreement to mediate for at least four hours at the location, time, and date listed in that letter.
2. I have read and understand the mediation process described in the mediation memorandum received from the mediator. If mediation does not succeed in resolving this dispute, I understand that the formal legal dispute process may be resumed as long as applicable time limits are met.
3. The parties agree that the entire mediation session is a compromise negotiation. All promises, proposals, conduct, and statements made in the course of the mediation session are confidential and will not be disclosed voluntarily to the extent permitted by law. See 5 U.S.C. 574. The Complainant/Grievant also agrees he/she will not disclose or discuss this settlement with other agency employees (except his or her representative and responsible management personnel). The Complainant/Grievant recognizes and authorizes the Air Force to disclose the terms of any settlement agreement to Air Force officials who may need to review and approve the terms of a settlement agreement.
4. ____ I will ____ I will not have a representative present at this mediation session.
5. I agree to conduct the mediation according to the terms of the mediator's memorandum.
Please sign and fax to your mediator as soon as possible!