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Family Mediator Certificate of Attendance and Status Report

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.
1.Your name(Required.)
2.Second mediator (if present)
3.Names of parties(Required.)
4.I certify that the above parties attended an initial mediation session with me.
5.Date of Mediation
Date
6.Case Number(Required.)
7.County where case is filed(Required.)
8.Court-ordered mediation?
9.Default mediator?
10.Number of sessions
11.Total number of hours mediating
12.Did the parties reach agreement on:
13.The issues mediated were:
14.Were attorneys present at any session?
15.Did you screen for domestic violence?
16.Comments
IMPORTANT
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Thank you.