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Mediation Feedback Survey
1.
Date of Mediation
Date
Date
January
February
March
April
May
June
July
August
September
October
November
December
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
Su
Sunday
Mo
Monday
Tu
Tuesday
We
Wednesday
Th
Thursday
Fr
Friday
Sa
Saturday
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
2.
Where was your case filed?
3.
Who was your mediator?
4.
Type of Case
Child in Need of Aid (CINA)
Custody or Divorce
Adult Guardianship
Minor Guardianship
Other (please specify)
5.
I am a:
Parent
Attorney for party
Tribal Representative
GAL
Court Visitor
OCS Worker
Other (please specify)
6.
Overall how satisfied are you with the mediator?
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
7.
Overall, how satisfied are you with the mediation process?
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
8.
I was able to share my thoughts and concerns.
Yes
No
9.
How likely are you to use mediation again?
Likely
Neither likely nor unlikely
Unlikely
10.
How was this mediation conducted?
In-person
Telephonic
Zoom
Other (please specify)
