Arbitrator Assessment Form U.S. District Court Eastern District of New York (Please Type Information If Possible) Case Number Arbitrator: Arbitration Panel? since appointment? Both Where? Case Caption How Long Have you Been on How many times have you served Brooklyn Long Island 1. 2. 3. Date matter received by you for hearing_____________ Date Hearing Scheduled Did the arbitration hearing take place? ______ Yes. Was more than 1 hearing date needed?_______ How Many _______ _______ No, case settled _______No, case was dismissed OTHER:________________________________________________ ________________________________________________ 4. Was an adjournment of the hearing requested and for what time period_______ Was an adjournment granted________ For what time period, 30 days 60 days 90 days More Reason adjourned________________________________________ ________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com Arbitrator Assessment (cont'd) 5. Did the parties appear to understand your role as Arbitrator? Yes__________ No__________ Were the parties cooperative? Yes_______ No_______ 6. (If no, explain)_______________________________________________ _______________________________________________________________ _______________________________________________________________ How was the problem resolved:__________________________________ _______________________________________________________________ 7. What do you think of the arbitration process? _____________________________________________________ _____________________________________________________ 8. If the program were voluntary, would you submit your case To arbitration in this Court? ____Yes ____No Explain:__________________________________________________ ______________________________________________________________ ______________________________________________________________ 9. How do you see the program improved in the future: ____________________________________________________ ____________________________________________________ -2- American LegalNet, Inc. www.FormsWorkFlow.com Arbitrator Assessment (cont'd) 10. Please provide the following information so that we may Update our records: Firm Name_____________________________ Address ______________________________ Telephone_________________________ Facsimile_________________________ E-Mail____________________________ The completed form should be sent to: U.S. District Court, EDNY 225 Cadman Plaza East Brooklyn, New York 11205 Attn: Arbitration Clerk (718) 260-2325 -3- American LegalNet, Inc. www.FormsWorkFlow.com