Thank You

Thank you for completing this certificate of attendance and survey. Your information is very valuable.  The mediator responses to this form are compiled and reported to the District Court Judges, the Iowa Judicial Branch, the committee that oversees the Family Mediation Program (MAC), and are posted on the MSEI website: mediateiowa.org. These responses inform critical decisions on process improvement. 

Please enter all information and click the 'Done' button when finished.

Question Title

* 3. Names of parties

Question Title

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

Question Title

* 5. Date of Mediation

Date

Question Title

* 6. Case Number

Question Title

* 8. Court-ordered mediation?

Question Title

* 9. Default mediator?

Question Title

* 10. Number of sessions

Question Title

* 11. Total number of hours mediating

Question Title

* 12. Did the parties reach agreement on:

Question Title

* 13. The issues mediated were:

Question Title

* 14. Were attorneys present at any session?

Question Title

* 15. Did you screen for domestic violence?

Question Title

* 16. Comments

IMPORTANT
After you click the Done button below, you may see ads from Survey Monkey about creating an account. THIS IS NOT NECESSARY. You may close (or exit out of) that window. This is usually done by clicking the "X" in the upper right corner of the window.

Thank you.

T