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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.

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

* 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)