Simply replace the unfilled areas such as "" and "[date]" with your information.
Dear [Mediation Official],
My [son/daughter], [Child] is a [Grade Level] at [School Name] in [Teacher's Name] class. I am writing to request that you mediate a dispute between the school and me. We are having a disagreement concerning [brief description of disagreement].
We have had several meetings and other correspondences in an attempt to find a solution. None of these have been successful. We simply cannot reach an agreement. I firmly believe that the only way to resolve this issue is to request mediation. It is important that this process begin as soon as possible.
Please let me know when we can schedule mediation. Also, send me any information I may need to prepare. You can contact me at [contact information].