Thank You

Thank you for completing this certificate of attendance and survey. Your information is very valuable. It is reported to the District Court Judges, the Iowa Judicial Branch, the committee that oversees the Family Mediation Program (MAC), and is posted on the MSEI website: mediateiowa.org. It informs critical decisions on process improvement. Please enter all information and click the Done button when finished.

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* 3. Names of parties

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* 4. I certify that the above parties attended an initial mediation session with me.

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* 5. Date of Mediation

Date

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* 6. Case Number

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* 8. Court-ordered mediation?

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* 9. Default mediator?

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* 10. Number of sessions

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* 11. Total number of hours mediating

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* 12. Did the parties reach agreement on:

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* 13. The issues mediated were:

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* 14. Were attorneys present at any session?

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* 15. Did you screen for domestic violence?

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* 16. Comments

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Thank you.

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