(Form 16) Date:__________________ Appellate Mediation Program Party Evaluation Mediator: _________________________________________________________________________________ Type of Case: [ ] _______________________________________________________________________ Other (specify): ____________________________________________________________________________ Your responses will serve as a guide to the appellate mediation office about changes or improvements that need to be made to the program. Your responses are confidential and will not be part of the appellate court file. I am the: ____Appellant ____Appellee ____Other (specify)_____________________________________ How did the case resolve? ____Full resolution ____Partial resolution ____No resolution ____Other (specify) _________________________________________________________________________ On a scale of 1(very dissatisfied) to 5 (very satisfied) please rate: The mediation process: ____Appropriateness of the process for your dispute ____Confidentiality ____Fairness ____Satisfaction with outcome ____Opportunity to participate Would you use this process again? ____Yes ____No On a scale of 1(very dissatisfied) to 5 (very satisfied) please rate: The mediator (name): ____________________________ ____Impartiality ____Knowledge of the appellate process ____Temperament ____Knowledge of the subject matter On a scale of 1(very dissatisfied) to 5 (very satisfied) please rate: Program administration: ____Efficiency (scheduling, etc.) ____Courtesy and cooperation ____Paperwork ____Mandatory participation Comments on the above, including suggestions for program improvements: __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ NOTE: PLEASE COMPLETE THIS FORM AT THE TIME MEDIATION IS COMPLETED AND RETURN TO APPELLATE MEDIATOR IN A SEALED ENVELOPE. (Revised 10/04) American LegalNet, Inc. www.USCourtForms.com