Mediation Survey Form. This is a New Jersey form and can be use in Bankruptcy Court Federal.
Tags: Mediation Survey, New Jersey Federal, Bankruptcy Court
DO NOT DOCKET THIS SURVEY FORM MEDIATION SURVEY TO: Mediator Litigants Attorneys We need your help to assist the court in compiling useful data to evaluate the effectiveness of the bankruptcy mediation program in this district. The information provided in this survey will be used solely for the purpose of evaluating this program. Please complete this form and return it within ___________ days to: United States Bankruptcy Court 402 East State Street Trenton, NJ 08608 Attention: Patricia L. Meravi, Mediation Program Administrator ****************************************************************************** 1. Identity of party completing this survey: ____ mediator ____ attorney ____ litigant 2 Source of referral of mediation: ____ motion/request of defendant ____ motion/request of plaintiff ____ consent request by both parties ____ bench referral ____ other (explain) __________________________________ 3. Manner of mediator selection: ____ parties Feb.1998 Mediation Survey, Page 1 American LegalNet, Inc. www.USCourtForms.com ____ court 4. Date case assigned to mediator: 5. Name of mediator: 6. Date of initial mediation session: _______________________________________ ___________________________________________________ _______________________________________ Date of final mediation session: _______________________________________ Number of mediation sessions: _______________________________________ 7. Number of hours spent on case by mediator: Hourly rate: $ ______________. Response optional: 8. Case Name: __________________________________ Amount of fees requested: $ ________________ _________________________________________________________ 9. Case No.: ___________________ Chapter: __7 __11 __12 __13 10. Adversary Name: ___________________________________________________ 11. Adversary No.: ___________________________________________________ For response by mediator only: 12. Did parties submit an adequate Information Statement? Were the attorneys prepared for the mediation sessions? Were the parties prepared for the mediation sessions? 13. Feb.1998 9 yes 9 yes 9 yes 9 no 9 no 9 no At what stage in the case did the mediation session take place? (Check all that apply.) ____ before any discovery Mediation Survey, Page 2 American LegalNet, Inc. www.USCourtForms.com ____ ____ ____ Feb.1998 during discovery after discovery after first trial date scheduled Mediation Survey, Page 3 American LegalNet, Inc. www.USCourtForms.com 14. Was the timing of referral to mediation appropriate? ____ too early ____ appropriate time ____ too late 15. Outcome/nature of agreement: ____ mediation held/full agreement on all issues ____ mediation held/some issues partially resolved ____ mediation held/no agreement ____ no mediation held/parties settled case before mediation session ____ no mediation held/party failed to attend ____ no mediation held/party attended but failed to participate 16. If the case did not settle in mediation, what were the reasons? (Check all that apply.) ____ the proper parties with authority to settle were not present ____ one or both parties did not mediate in good faith ____ one or both parties too entrenched in their positions ____ issues were too complex ____ issues were too numerous 17. Relationship of the parties: ____ formal business relationship (e.g. partnership, corporation, etc.) ____ performance of service contract ____ family ____ neighbor ____ friend ____ no ongoing relationship ____ other (explain) ________________________________ 18. What was the type of proceeding? ____ non-dischargeability (specify basis: § 523(a) (_______) ____ objection to claim ____ preference ____ fraudulent transfer ____ turnover ____ administrative expense ____ valuation Feb.1998 Mediation Survey, Page 4 American LegalNet, Inc. www.USCourtForms.com ____ ____ Feb.1998 chapter 11 plan provisions other (specify) ________________________________ Mediation Survey, Page 5 American LegalNet, Inc. www.USCourtForms.com 19. How much money was involved in the dispute? ____ under $5,000 ____ $5,001 to $10,000 ____ $10,001 to $50,000 ____ $50,001 to $100,000 ____ $100,001 to $500,000 ____ over $500,001 ____ non-monetary issue (specify) ____________________________ ___________________________ 20. The plaintiff or movant was a[n]: ____ trustee ____ individual ____ corporation ____ partnership ____ Internal Revenue Service ____ other (specify) ___________________________________ 21. The defendant or respondent was a[n]: ____ trustee ____ individual ____ corporation ____ partnership ____ Internal Revenue Service ____ other (specify) __________________________________ 22. Characteristics of cases you feel are amenable to resolution in mediation: ____ relatively simple issues ____ more complex issues ____ ongoing relationship between parties ____ parties entrenched in positions ____ multiple parties ____ other (specify) __________________________________ __________________________________ Feb.1998 Mediation Survey, Page 6 American LegalNet, Inc. www.USCourtForms.com 23. Do you think that mediation: ! generally preserves the legal rights of clients? ! generally results in equitable outcomes? For response by litigants and attorneys: 24. As to you or your client, do you think the mediator in this case: ! gave you a full opportunity to convey your interest? ! was impartial? ! was helpful in attempting to resolve this case? ! understood the issues in this case? ! was knowledgeable about the law relative to this case? 9 yes 9 yes 9 no 9 no 9 yes 9 yes 9 yes 9 yes 9 no 9 no 9 no 9 no 9 yes 9 no 25. Did you feel pressured to reach an agreement in mediation? ____ no ____ yes, by the mediator ____ yes, by the other side ____ yes, by time or money constraints 26. What impact did mediation have on this case? ____ settled the case ____ clarified positions ____ settled some of the issues ____ added unnecessary steps ____ moved the case significantly toward settlement ____ increased tension ____ other (specify) ________________________________________ 27. Do you think mediation in this case saved money? Do you think mediation in this case saved time? Feb.1998 9 yes 9 yes 9 no 9 no Mediation Survey, Page 7 American LegalNet, Inc. www.USCourtForms.com Would you consider mediation for other matters? 28. 9 no Please use this space to add any other comments about your experience in mediation. Include what you disliked about the mediation process; what you liked about it; how the mediation program can be improved, etc. Date survey completed:_______________ Feb.1998 9 yes ___________________________________ (Name of party completing survey) Mediation Survey, Page 8 American LegalNet, Inc. www.USCourtForms.com