Form 2 IN THE SUPREME COURT OF ALABAMA or ALABAMA COURT OF CIVIL APPEALS Date: Case Number: Style: MEDIATION CASE-SCREENING FORM This screening form is sent to obtain information to be used by the appellate mediation administrator in determining whether this case is an appropriate one for appellate mediation. Each party must file a copy of the completed Mediation Case-Screening Form and the Confidential Statement to Enter Appellate Mediation with the Appellate Mediation Office, 300 Dexter Avenue, Montgomery, Alabama 36104, within 14 days of the date of this notice, and serve a copy of the completed Mediation Case-Screening Form on opposing counsel. In addition to the documents required in the first paragraph, the appellant shall attach (1) a copy of the docketing statement, (2) a copy of the complaint and any amendments to the complaint; (3) a copy of the order or judgment to be reviewed by the appellate court; (4) a copy of the order on any postjudgment motion, if applicable; and (5) a copy of the postjudgment motion if it will assist the administrator to determine the nature of the dispute. FAILURE TO RETURN THE MEDIATION CASE- SCREENING FORM MAY RESULT IN SANCTIONS (SEE RULE 5 (i)). ____________________________________________________________________________ Appellant’s attorney Alabama Bar No. (Lead counsel: If different from the attorney listed on the docketing statement.) ____________________________________________________________________________ Address, City, State, Zip ____________________________________________________________________________ Phone Fax E-mail American LegalNet, Inc. www.FormsWorkflow.com ____________________________________________________________________________ Appellee’s attorney Alabama Bar No. (Lead counsel: If different from the attorney listed on the docketing statement.) ____________________________________________________________________________ Address, City, State, Zip ____________________________________________________________________________ Phone Fax E-mail ISSUES ON APPEAL (to be completed by appellants/cross-appellants only): Are there any issues you expect to be raised on appeal that are not listed on the docketing statement? If so, please attach to this form a statement of those additional issues. IN FORMA PAUPERIS Were you granted leave to proceed in forma pauperis on appeal at the trial level? If so, attach a copy of the order granting such leave. MEDIATION Was the case mediated at the trial level? Yes _______ No _______ Has the case been mediated since entry of the order appealed? Yes _______ No _______ THE APPELLANT IS TO ATTACH A COPY OF THE DOCKETING STATEMENT, A COPY OF THE COMPLAINT AND ANY AMENDMENTS TO THE COMPLAINT, A COPY OF THE ORDER OR JUDGMENT TO BE REVIEWED BY THE APPELLATE COURT, A COPY OF THE ORDER ON ANY POSTJUDGMENT MOTION, IF APPLICABLE, AND A COPY OF THE POSTJUDGMENT MOTION IF IT WILL ASSIST THE ADMINISTRATOR TO DETERMINE THE NATURE OF THE DISPUTE. _________________________ Date _________________________________________ Signature Print Name Lead counsel for: CERTIFICATE OF SERVICE American LegalNet, Inc. www.FormsWorkflow.com