IN THE DISTRICT COURT OF APPEAL FOR THE STATE OF FLORIDA FIFTH DISTRICT , Appellant(s), v. Appellate Case No: 5D County Case No: , Appellee(s), / MEDIATION EVALUATION For Mediators Only Please take a few minutes to complete this form and return it to: Penny H. Cooper, Mediation Coordinator Fifth District Court of Appeal 300 South Beach Street Daytona Beach, FL 32114 [Your responses will serve as a guide to the Court about changes or improvements which need to be made to the program. Your responses are confidential and will not be part of the appellate court file.] 1. WHAT KIND OF PROBLEM OR CASE WAS MEDIATED? (please select one) Business Tort Employment Insurance Real Estate Other (please describe) 2. Contract _Family matter (with children issues) Family matter (without children issues) Personal injury/wrongful death WAS THE APPEAL FROM A: Summary Judgment Final Judgment after non-jury trial Final Judgment after jury trial Other Final appealable order American LegalNet, Inc. www.FormsWorkflow.com 3. WAS THE PROBLEM OR CASE RESOLVED THROUGH MEDIATION AT THE APPELLATE LEVEL? Yes, completely No, made no progress Made situation worse Partially resolved (some issues stipulated to or resolved) Issues or disputes directly involved in this appeal partially resolved Issues or dispute not directly involved in this appeal resolved or partially resolved Somewhat helpful in clarifying and simplifying issues for appeal Other (please describe) 4. ARE ATTEMPTS TO SETTLE THE APPEAL STILL ONGOING? 5. WOULD YOU RECOMMEND APPELLATE MEDIATION? Yes No Please explain (optional) 6. Date PLEASE SUGGEST HOW YOU THINK WE CAN IMPROVE THE APPELLATE MEDIATION PROGRAM. Signature The Mediator should file this report with Penny H. Cooper, Mediation Coordinator, Fifth District Court of Appeal, 300 South Beach Street, Daytona Beach, Florida 32114. American LegalNet, Inc. www.FormsWorkflow.com