MED-100 (6/15)(cs) REQUEST FOR COURT-SPONSORED GUARDIANSHIP MEDIATION IN THE SUPERIOR COURT FOR THE STATE OF ALASKA AT In the Matter of the Protective Proceeding of ) ) ) ) Respondent/Ward or Protected Person ) ) CASE NO. REQUEST FOR COURT-SPONSORED GUARDIANSHIP MEDIATION 1.I request a referral to the court-sponsored guardianship mediation program.2.I am the: Respondent/Ward (or attorney) Petitioner (or attorney) Court Visitor GAL Guardian or Conservator Other (family, domestic partner, etc.) and my relationship to the person is: 3. I consulted with all other legal parties and we all agree to make this referral (not required).4.The participants are available to mediate on (date) at am pm or (date) at am pm. 5.People who should participate in the mediation are: Name Relationship Phone(s) and Email address NOTE: If you need to add more names, please attach an additional sheet. 6.Mediation should focus on the following areas or issues of concern: Date: Signature I certify that on Type or Print Name a copy of this request was sent to: GAL Mailing Address Petitioner or Atty. Guardian Court Visitor Conservator City State ZIP Family Case Services Coordinator Other Contact Telephone Number(s) By: American LegalNet, Inc. www.FormsWorkFlow.com