Request mediation for yourself

If you want to request mediation for yourself, fill in the form below.

To request mediation for someone else, fill in the Request mediation on behalf of someone else form.

Required fields are marked with an asterisk (*).

My details

Given name *

Family name *

Daytime phone number *

Email address

Postal address We need your email or postal address to send you updates on your case.

Would you like us to contact you through an interpreter?

Preferred language *

Preferred gender of interpreter

How did you hear about us? *

Other participant details

This is the person you would like to mediate with.

Given name *

Family name *

Daytime phone number

Email address

Postal address We need their email or postal address to contact them about your request for mediation.

Are we best to contact them through an interpreter?

Language spoken *

Have they agreed to this mediation request?

Do you give us permission to contact them about your request for mediation? *

Are there other people involved?

Provide details *

Dispute summary

Tell us briefly about the dispute.

Summary

Privacy statement

The Community Justice Centre (CJC) is a service of the Northern Territory Government Department of the Attorney-General and Justice.

The CJC respects your rights to your privacy. The information you submit in this online request will be held by the CJC for the purpose of providing a mediation service. All information is collected, stored, used and disclosed in accordance with the information privacy principles contained in the Information Act 2002. To find out more, read the Act or go to the Office of the Information Commissioner NT.

Read the full privacy statement.

For more information, contact the CJC on 1800 000 473.