034 acta de mediacion formato

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034 acta de mediacion formato

  1. 1. INSTITUCION EDUCATIVA JOSE MARIA CARBONELL ACTA DE MEDIACION ACTUACION Tipo de actuación: _____________________________________________________ ___________________________________________________________________ DATOS BASICOS Mediador (es):_________________________________________________________ Partes del conflicto: _____________________________________________________ Fecha: ______________________________________________________________ Temas: _______________________________________________________________ NARRACION DE LOS HECHOS _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ ACUERDOS ______________________________________________________________________ ______________________________________________________________________ OBSERVACIONES _______________________________________________________________________ ________________________________________________________________________ _______________________________________________________________________ SEGUIMIENTO _________________________________________________________________________ _______________________________________________________________________ FIRMAS: MEDIADORES: 1) NOMBRE: ___________________________ FIRMA______________________ 2) NOMBRE:____________________________FIRMA_______________________ ACTORES DEL CONFLICTO 1) NOMBRE: _________________________ CURSO___ FIRMA________________ 2) NOMBRE__________________________CURSO ___FIRMA________________

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