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This is a sample Agreement to Mediate from the U.S. Department of Health and Human Services, Food and Drug Administration

Agreement to Mediate

The parties agree to engage in mediation to try to resolve issues raised during the alleged employment discrimination complaint process. The parties understand that mediation is voluntary and may be ended at any time.

The parties understand that the mediator(s) has no authority to decide the case and is not acting as advocate or attorney for any party.

All communications between the mediator and the disputants are held confidential to the maximum extent possible except in cases of fraud, abuse or criminal activity. Any documents submitted to the mediator(s) and any statements made during the mediation are for settlement purposes only. The parties agree not to subpoena the mediator(s) or any documents prepared by or submitted to the mediator(s). In no event will the mediator(s) voluntarily testify for any party or submit any type of report concerning this mediation. Confidentiality will not extend to threats of imminent physical harm.

No party is bound by anything said or done at the mediation unless an agreement is reached and executed by all necessary parties. If an agreement is reached, it will be reduced to writing and, when signed and approved by the appropriate authorities for all parties, will be binding upon all parties to the agreement.

The parties agree that the mediator has the right to end the mediation at any time if the mediator feels that the case is inappropriate for mediation or that further discussions would not be helpful.

By signature below, we acknowledge that we have read, understand, and agree to this mediation process.

________________________________________
Aggrieved Person/Complainant
_________________
Date
________________________________________
Management/Settlement Official
_________________
Date
________________________________________
Mediator(s)
_________________
Date