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Mediation Participant Survey
Mediation Participant Survey
Please complete this survey. Your answers are important to us. If you have any questions, please ask. Your answers to this survey
will not
influence the outcome of your case. This survey is for program analysis only.
1.
What is your case number?
*
2.
What was your mediator's name?
(Required.)
*
3.
What type of case is this?
(Required.)
Civil
Delinquency
Adult Contributing
Dependency, Neglect, and Abuse
Permanent Custody
*
4.
What were the results of your mediation?
(Required.)
Complete agreement reached
Partial agreement reached
Interim agreement reached
No agreement reached
Screened out
Respondent failed to appear
Petitioner failed to appear
*
5.
What best describes your role in this mediation?
(Required.)
Parent or legal custodian
Minor Child
Attorney
Person affiliated with a school
Mental Health Professional
Children Services Bureau Caseworker or Attorney
Guardian Ad Litem or CASA
Probation Officer
Other
Other (please specify)
6.
During the mediation, would you say that...
You didn't have enough time to talk
You had enough time to talk
You had too much time to talk
7.
During the mediation, did you feel that the mediator listened to you?
yes
somewhat
no
8.
Did you feel that the mediator...
favored you
was neutral or fair to both sides
favored the other side
9.
Did you understand the problem or situation better after the mediation?
yes
somewhat
no
10.
Do you feel like you understand the other person better after the mediation?
yes
somewhat
no
11.
Which of the following best describes how you feel about the mediation?
satisfied
somewhat satisfied
unsatisfied
*
12.
For any future mediations, what would be your preferred format?
(Required.)
In-Person Mediations at Court
Virtual Mediations via Zoom
13.
What is your age?
0-14 years of age
15-17 years of age
18-44 years of age
45-64 years of age
65 years of age or older
Prefer not to answer
14.
What is your gender?
male
female
other
Prefer not to answer
15.
Which race/ethnicity best describes you? (Please choose only one.)
American Indian or Alaskan Native
Asian / Pacific Islander
Black or African American
Hispanic
White / Caucasian
Prefer not to answer
Multiple ethnicity / Other (please specify)
16.
What is the highest level of school you have completed or the highest degree you have received?
Less than high school degree
High school degree or equivalent (e.g., GED)
Some college but no degree
Associate degree
Bachelor degree
Graduate degree
Prefer not to answer
17.
In what ZIP code is your home located? (enter 5-digit ZIP code; for example, 00544 or 94305)
18.
Do you have any other comments, questions, or concerns?