U.S. Department of Transportation

Equal Employment Opportunity/Equal Opportunity

Alternative Dispute Resolution

 

 

REQUEST FOR MEDIATION

 

 

 

I request that my complaint be considered for mediation.  I understand that the agency is not offering mediation, and that I may not elect mediation until such an offer is made.  I further understand that the agency will consider my request, and make an assessment of the complaint’s appropriateness for mediation.  If the agency offers mediation, at that time, I will have five calendar days to make an election to participate in the mediation process.  If however, I choose not to elect mediation, I may continue processing my EEO/EO Complaint in accordance with 29 CFR, Part 1614. and/or U.S. Coast Guard Manual, Commandant Instruction M5350.4

 

 

 

 

__________________________                                                        __________________

Aggrieved/Complainant                                                                    Date

 

 

 

 

 

This request will be forwarded to the Operating Administration’s EEO/EO Designated Official or the Departmental Mediation Coordinator (DMC).