IN THE OFFICE OF DISPUTE RESOLUTION OF GWINNETT COUNTY STATE OF GEORGIA Plaintiff Civil Action No. vs. Defendant MEDIATION REPORT The results of the above-styled session are as follows: _____ FULL AGREEMENT Court's original to be prepared by: Consent order or dismissal to be prepared by: _____ PARTIAL AGREEMENT Court's original to be prepared by: The issues remaining are: _____ NO AGREEMENT _____ NO AGREEMENT was reached today, but it is the determination of this mediator and the parties involved that an agreement is likely. Therefore, _____Another session has been scheduled for (circle one), , 20 , at 9:00 a.m. or 1:00 p.m. at the Gwinnett Justice and Administration Center. _____We will call the court to schedule another session at the Gwinnett Justice & Administration Center. _____ NO SHOW was present for the session. However, did not appear at the scheduled time. _____ OTHER American LegalNet, Inc. www.FormsWorkFlow.com Compensation status for mediation services: _____ Paid in full by both parties. _____ Payment is due from in the amount of _____ Stipend from ADR fund. _____ Pro Bono case. _____ Mediation calendar. _____ Other: Present at this mediation session were: Affiliation Name The mediation session was from (a.m.\p.m.) to Plaintiff Defendant Plaintiff Attorney Defendant Attorney Mediator (a.m.\p.m.). Date FORWARD THE ORIGINAL OF THIS FORM TO: Administrative Office of the Courts Attn: Alternative Dispute Resolution 75 Langley Drive Lawrenceville, GA 30046-6935 Fax # (770) 822-8588 American LegalNet, Inc. www.FormsWorkFlow.com