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Statewide Civil, General Equity and Probate Mediation Program

Mediation Case Information Form

Directions: This form is to be completed by the mediator when the mediation is concluded or returned to court.

Question Title

Case Docket Number (e.g. L-000067-10)

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County

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Name of Mediator

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Outcome/Nature of Agreement

mediation held/full agreement on all issues

mediation held/some issues pending

mediation held/no agreement

no mediation held/parties settled case before mediation session

no mediation held/party failed to attend

no mediation held/party attended but failed to participate

Question Title

Number of mediation sessions

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Number of hours of preparation time

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Number of hours in sessions

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Number of hours billed to the parties

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At what stage in the case did the mediation sessions take place? (note all that are applicable)

before any discovery

before depositions

after depositions

after interrogatories and document production

after experts' reports served

Other (please specify)

Question Title

* Case Docket Number (e.g. L-000067-10)

Question Title

* County

Question Title

* Name of Mediator

Question Title

* Outcome/Nature of Agreement

Question Title

* Number of mediation sessions

Question Title

* Number of hours of preparation time

Question Title

* Number of hours in sessions

Question Title

* Number of hours billed to the parties

Question Title

* At what stage in the case did the mediation sessions take place? (note all that are applicable)

Case Docket Number (e.g. L-000067-10)

County

Name of Mediator

Outcome/Nature of Agreement

Number of mediation sessions

Number of hours of preparation time

Number of hours in sessions

Number of hours billed to the parties

At what stage in the case did the mediation sessions take place? (note all that are applicable)