Mediators Status Report
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Mediators Status Report Form. This is a Illinois form and can be use in Fulton Local County.
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Tags: Mediators Status Report, Illinois Local County, Fulton
IN THE CIRCUIT COURT OF THE NINTH JUDICIAL CIRCUIT
COUNTY, ILLINOIS
Petitioner,
vs.
Case No:
Respondent.
MEDIATOR’S STATUS REPORT
(Local Court Rule G-5.B.8.g.1)
Name of Mediator:
Referring Judge:
(Check Appropriate Boxes)
[ ] I am unable to accept the court’s appointment to provide mediation services for the following reason(s):
[ ] Conflict of Interest
[ ] Parties failed to meet terms of engagement
[ ] Full Caseload
[ ] Other:
The following mediation sessions were conducted:
Date of Session
Duration of Session
Those in Attendance
[ ] Mediation was terminated without an agreement.
[ ] Additional mediation sessions are recommended; there appears a reasonable chance of agreement.
[ ] An agreement was reached by the parties on some or all of the issues; a report of their agreement has
been sent to their attorney(s) for preparation and submission to the Court.
[ ] A written agreement was reached by the parties on some or all of the issues and a copy of their signed
agreement [ ] is [ ] is not attached to this report.
[ ] The appointment of a child representative or guardian ad litem [ ] is [ ] is not recommended.
[ ] A custody/psychological evaluation of the family is recommended.
[ ] Other:
FEES
I charged a [ ] regular [ ] reduced [ ] pro bono fee of $
for mediation services.
My fee has been paid in full.
Petitioner owes a balance of $
as of the date of
.
Respondent owes a balance of $
as of the date of
.
I request that the court order the parties to pay their outstanding balance, or set a hearing on the
disputed amount.
[ ] I charged no fee as required for my pro bono work required by local court rules.
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Dated:
Mediator
Print Name:
Rev 4-27-07
Page 1 of 1
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