Mediation Availablity
Date Preferred
Other Possible Date
Session Requested
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FULL DAY
HALF DAY
SIX HOURS
If half-day is requested- any preferences:
Morning
Afternoon
Has the date been confirmed with all parties
Morning
Afternoon
How would like the mediation to be conducted?
Via Zoom video office
In person
First Name of person completing this form
Last Name
Complete Style of Case or Case Name
Cause No. (If any)
Court (If any)
Brief Description of Matter
CONTACT INFORMATION
Name of Party
Type
Petitioner
Respondent
Intervenor
Plainiff
Defendent
Not Applicable
Attorney's Name(if represented)
Attorney's Email (if represented)
Party's Email ( if no attorney)
Mailing Address of Attorney or Unrepresented Party
Phone number of Attorney or Unrepresented Party
Name of Party
Type
Petitioner
Respondent
Intervenor
Plainiff
Defendent
Not Applicable
Attorney's Name(if represented)
Attorney's Email (if represented)
Party's Email ( if no attorney)
Mailing Address of Attorney or Unrepresented Party
Phone number of Attorney or Unrepresented Party
STATUS OF CASE
In Litigation?
YES
NO
Key Date
Payment of Fees
50/50 Split
other
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