RHODE ISLAND SUPREME COURT APPELLATE MEDIATION PROGRAM MEDIATION ELIGIBILITY FORM AND CONFIDENTIAL MEDIATION STATEMENT INSTRUCTIONS This is a two-part, double-sided form. Part I determines the eligibility and appropriateness of your case for mediation. Part II applies to eligible cases only and contains confidential information about your case in order to assist the mediator in a resolution as well as an authorization to mediate. 1. Pursuant to Supreme Court Rule 35, all parties must complete this form and submit it to the Supreme Court Appellate Mediation Program within twenty (20) days of filing a Notice of Appeal. All parties must send an original and two copies of Part I to the Appellate Mediation Program and one copy to all opposing counsel. 2. If your case is not eligible for mediation pursuant to Rule 35, you need not complete Part II of this form. Send the original and two copies only of Part I to the Appellate Mediation Program and one copy to opposing counsel. 3. If your case is eligible for mediation, you are required to complete Part II of this form as well. While Part I of the attached form is to be shared with opposing counsel, Part II provides parties an opportunity to inform only the mediator of additional information that could lead to resolution. Candor and honesty are strongly encouraged. a. Complete fully Part II (the confidential mediation statement) inclusive of the confidentiality and negotiation authorization section. Attach copies of the relevant orders, memoranda, and opinions from which this appeal has been taken. If you are the appellant(s) or cross-appellant(s), you are required to attach copies of the trial court's written decision(s) or order(s). b. Send the original and two copies of the form to the Appellate Mediation Program at the address indicated. Retain a copy to bring to the mediation session when assigned. Do NOT send a copy of Part II (the confidential mediation statement) to opposing counsel. 4. If after submission of your statements, it is determined that your case is not eligible or not appropriate for mediation, the parties will be sent notification by the Appellate Mediation Program that the case has not been selected. 5. If after submission of your statements, your case is deemed eligible and appropriate for mediation, the Appellate Mediation Program will send notice of the scheduled session to all parties. Please make every effort to have counsel and clients available on the assigned date and time. MEDIATION SESSIONS ARE ONLY ALLOWED TO BE RESCHEDULED ONCE FOR GOOD CAUSE. A request to reschedule must be made at least seven (7) days before the session. 6. To adequately prepare for mediation, counsel should become fully aware of his/her client's interests, goals, and needs and acquire appropriate authority to participate in the mediation conference and the potential settlement. Counsel should further educate his/her client regarding the mediation process and its possible outcomes. We strongly suggest that you refer to the Appellate Mediation Program's "Mediation Tip Sheets" for counsel and clients in preparation for your session. 7. Please note that even if your case proceeds to mediation the Appellate Rules of Procedure are NOT suspended; only the time within which to order the transcript and transmit the record is extended. Should you need additional time, it is recommended that you file a motion with the Court for an extension. AMP7/Rev.54/2013 American LegalNet, Inc. www.FormsWorkFlow.com RHODE ISLAND SUPREME COURT APPELLATE MEDIATION PROGRAM PART I: MEDIATION ELIGIBILITY FORM NAME OF CASE NAME OF PERSON FILING THIS STATEMENT COUNSEL FOR (NAME OF PARTY) TRIAL COURT CASE NUMBER DATE APPEAL FILED FILING STATUS (Check all that apply) PRO SE APPELLANT CROSS-APPELLANT APPELLEE CROSS-APPELLEE OTHER:___________________________________ ADDRESS TEL CASE TYPE: Agency Appeal Business Organization Contract FAX Employment Personal Injury Personal Property Will EMAIL RI BAR # Miscellaneous Other Civil Action Other Probate Appeal Other ___________________________________________ ALL CASES ARE ELIGIBLE EXCEPT IF THE BASIS OF THIS APPEAL INVOLVES ANY OF THE FOLLOWING: (Please check all that apply. This section determines whether your case is eligible and whether you must complete Part II*) Application for post conviction relief Petition for habeas corpus Case brought by a prisoner in the custody of the Department of Corrections Criminal case (including cases on review from municipal court or traffic court) Petition for extraordinary relief (including prerogative writs) Juvenile case Appeal from Family Court Pro se representation Not a trial court appeal DOES THIS APPEAL INVOLVE ANY OF THE FOLLOWING? Final judgment has not been entered Multiple parties State or federal constitutional interpretation Inconsistency in decisions of Supreme Court Validity of state statute, ordinance or agency requirement Motions to file amicus briefs (if known) Motions to intervene (if known) Motion(s) to stay appeal pending resolution of related case Issue of first impression Other procedural complexity: _________________________ HAS THIS CASE OR A RELATED CASE BEEN BEFORE THE SUPREME COURT PREVIOUSLY? NO YES, CASE NAME AND NO. ______________________________________________________________ STATE ANY OTHER FACTORS AFFECTING THE APPROPRIATENESS OF THIS CASE FOR MEDIATION PLEASE DESCRIBE THE UNDERLYING FACTS THAT GAVE RISE TO THE INITIAL DISPUTE DESCRIPTION OF PHYSICAL INJURY, MONETARY, OR ANY OTHER DAMAGES UPON WHICH THE CLAIM FOR COMPENSATION OR EQUITABLE ACTION IS BASED OUT-OF-POCKET EXPENSES, IF ANY, UPON WHICH THE CLAIM IS BASED Turn over American LegalNet, Inc. www.FormsWorkFlow.com RHODE ISLAND SUPREME COURT APPELLATE MEDIATION PROGRAM PART I. MEDIATION ELIGIBILITY FORM Continued BRIEFLY DESCRIBE THE JUDGMENT/RULING APPEALED: MAJOR POINTS OF ERROR OR ISSUES THAT ARE THE FOCUS OF THE APPEAL: HISTORY OF SETTLEMENT NEGOTIATIONS, IF ANY (Please include a listing of all demands and counteroffers) PLEASE LIST NAMES AND ADDRESSES OF ALL OTHER COUNSEL INVOLVED IN THIS MATTER PARTY REPRESENTED NO SIGNATURE ARE YOU COURT EXCUSED AT ANY TIME DURING THE NEXT 3 MONTHS? YES, ON THE FOLLOWING DATES:_________________________________________________ DATE Send a copy of Part I to opposing counsel and the original and two copies to the Appellate Mediation Program, Rhode Island Supreme Court, 250 Benefit Street, Providence, Rhode Island 02903 Telephone: (401)222-8661. *If this app