* 1. OAH case number

* 2. Define your participation.

* 3. Did you participate in person or by telephone?

* 4. Where do you live?

* 5. Including this one, how many mediations at the Office of Administrative Hearings have you participated in?

* 6. Was an agreement reached?

* 7. Are you satisfied with the agreement?

* 8. Evaluation for the Administrative Law Judge (ALJ)

  excellent adequate poor
ALJ's preparation
ALJ's respectfulness toward you
ALJ's explanation of the mediation process
ALJ's willingness to listen and understand my issues
ALJ's ability to faciliate a resolutiuon

* 9. Overall Evaluation

  agree disagree no comment
Overall, I felt the mediation process was a positive experience
I would recommend mediation to a person involved in a similar dispute
I would recommend this mediator to a person involved in a similar dispute
The mediation helped me understand the other side's point of view

* 10. Comments

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