What is a Request for Mediation form?

The Request for Mediation form is the form that must be used to request mediation. You may obtain the form:

• By calling WSEMS at 1-888-298-3857
• You may download the form by clicking on the Request for Mediation form

The form is simple to complete. The person(s) requesting mediation briefly describes the dispute. The WSEMS Intake Coordinator/Administrator, Jane Burns, can provide assistance in completing the form. Jane Burns may be reached at 1-888-298-3857.

The form should be signed and faxed to WSEMS at 262-538-1348 or mailed to WSEMS, P.O. Box 829, Madison, WI 53701-0829