MEDIATION INITIATION FORM Case:_____________________________________ C/A No.:__________________________________Please check the applicable box to indicate the status of the above referenced case: case settled prior to or without mediation case dismissed by court or pending ruling on summary judgment motion case to proceed to trial case continued to next term OR case will be or has been mediated (complete the following information):Mediator Name: ___________________________Mediator Phone No.___________________Date Mediation Scheduled to Occur or Date Mediation Completed:______________________Submitted by:_______________________________ Signature:_________________________ (Printed name of counsel)For which party?:______________________________________ Date:___________________ (Name of party counsel represents)Please fax completed form to Danny Mullis, ADR Program Director @ 843-579-1434 or mail to P.O.Box 835, Charleston, SC 29402.