Mediation Request Form

To request mediation, please complete the form below and press submit.

Or, you may download the form here [PDF] and submit it to:

Michigan Agricultural Mediation Program
c/o Dispute Resolution Center of West Michigan
678 Front Ave. NW, Suite 250
Grand Rapids, MI 49504-5368

Phone: (616) 774-0121

Fax: (616) 774-0323

Email: info@drcwm.org

The form must be submitted within 30 days from the date of any adverse determination letter.

Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.), should contact USDA’s TARGET Center at (202) 720-2600
(voice and TDD).

USDA prohibits discrimination against its customers. If you believe you experienced discrimination when obtaining services from USDA, participating in a USDA program, or a program that receives financial assistance from USDA, you may file a complaint with USDA. OASCR, through the Office of Adjudication, will investigate and resolve complaints of discrimination in programs operated or assisted by USDA.

USDA prohibits discrimination on the bases of race, color, religion, sex, age, national origin, marital status, sexual orientation, familial status, disability, limited English proficiency, or because all or a part of an individual’s income is derived from a public assistance program. In programs that receive Federal financial assistance from USDA, discrimination is prohibited on the bases of race, color, religious creed, sex, political beliefs, age, disability, national origin, or limited English proficiency. (Not all bases apply to all programs.) Reprisal is prohibited based on prior civil rights activity.

To file a program discrimination complaint, please complete the USDA Program Discrimination Complaint Form here:

https://www.ascr.usda.gov/sites/default/files/Complain_combined_6_8_12_508_0.pdf

You or your authorized representative must sign the complaint form. You are not required to use the complaint form. You may write a letter instead. If you write a letter, it must contain all of the information requested in the form and be signed by you or your authorized representative. Incomplete information will delay the processing of your complaint. Employment civil rights complaints will not be accepted through this email address.

Send your completed complaint form or letter to the USDA by mail, fax, or email:

U.S. Department of Agriculture
Director, Office of Adjudication
1400 Independence Avenue, SW
Washington, DC 20250-9410

Phone: (866) 632-9992
Fax: (202) 690-7442
Relay Voice Users: (866) 377-8642
Email: program.intake@usda.gov

USDA is an equal opportunity provider and employer.

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