IN THE DISTRICT COURT OF APPEAL STATE OF FLORIDA FIFTH DISTRICT , Appellant(s), v. Appellate Case No: 5D County Case No: , Appellee(s). / MEDIATION EVALUATION For Parties 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 Contract Employment Family matter (with children issues) Insurance Family matter (without children issues) Real Estate Personal injury/wrongful death Other (please describe) ________________________________________ 2. WAS YOUR 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 YOUR 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 disputes 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 YOUR APPEAL STILL ONGOING? 5. THE SERVICE PROVIDED BY THE MEDIATOR [NAME Helped a great deal Helped some ] Made no difference Made things worse 6. WOULD YOU RECOMMEND APPELLATE MEDIATION? 7. PLEASE SUGGEST HOW YOU THINK WE CAN IMPROVE THE APPELLATE MEDIATION PROGRAM. Date Yes No Signature Parties 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