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The University of Southampton

Self-referral form

Use this referral form if you are a member of staff or student who wishes to refer themselves to the Mediation Service

Thank you for completing this form. Once submitted you will be contacted by the Mediation Service shortly to discuss what happens next.

Mediation is confidential and all information relating to it, including the fact that you have approached the Mediaton Service will remain confidential and will not be disclosed to a third party.

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