FOR OFFICE USE ONLY State of New Jersey DATE RECEIVED: LITIGANT QUESTIONNAIRE DATE ENTERED – AOC: Statewide Civil, General Equity and Probate Mediation Program DIRECTIONS: This form is to be completed by the litigant at the conclusion of mediation. CASE DOCKET NUMBER COUNTY THE MEDIATOR FOR THIS CASE WAS SELECTED BY: DID YOU PARTICIPATE IN MEDIATION AS OR ON BEHALF OF THE PLAINTIFF OR DEFENDANT? court/judge parties/attorneys DID YOU HAVE FULL AUTHORITY TO ENTER INTO A SETTLEMENT IN THE MEDIATION OF THE CASE? plaintiff defendant yes no DO YOU THINK THE MEDIATOR IN THIS CASE: yes no Gave you a full opportunity to convey your interests? yes no Was knowledgeable about the law relative to this case? yes no Was impartial? yes no Understood the issues in this case? WHAT IMPACT DID MEDIATION HAVE ON THIS CASE? Settled the case Moved the case significantly toward settlement Added unnecessary steps Settled some of the issues Clarified positions Increased tension DID YOU FEEL PRESSURED TO REACH AN AGREEMENT IN MEDIATION: DO YOU THINK MEDIATION IN THIS CASE SAVED YOU MONEY? no yes no Other: yes, by the mediator DO YOU THINK MEDIATION IN THIS CASE SAVED TIME? yes, by the other side yes no yes, by time or money constraints WOULD YOU RECOMMEND MEDIATION TO A FRIEND? yes no PLEASE USE THIS SPACE TO ADD ANY OTHER COMMENTS ABOUT YOUR EXPERIENCE IN MEDIATION: PLEASE RETURN TO: Revised 6/21/2005, CN 10525-english AOC - CIVIL PRACTICE DIVISION BOX 981 TRENTON, NJ 08625 FAX: 609 777-0844 page 1 of 1 American LegalNet, Inc. www.FormsWorkflow.com