MEDIATION REPORTING FORM Cause No. Style of Case: IN THE MATTER OF THE MARRIAGE OF: and Petitioner's Attorney/Pro Se Name: Respondent's Attorney/Pro se Name: Nature of Case (Check one): Divorce Post Divorce Other MEDIATION EXPERIENCE (Check Appropriate Space): Mediation was not used in this case (If mediation was not used, go no further) Mediation was used in this case. Mediation was Court-ordered Mediation was voluntary The case settled The case did not settle in mediation The case settled later, but not in mediation Mediation was helpful in the following areas: (Please check the areas listed below) Enabling communication between parties; Narrowing the issues; Establishing a basis for future communication; Other: __________________________________________________________ Mediation not helpful in the following areas: (Please check the areas listed below) Enabling communication between parties; Narrowing the issues; Establishing a basis for future communication; Other: __________________________________________________________ COMMENTS: _____________________________________ _____________________________________ Date Finalized American LegalNet, Inc. www.FormsWorkFlow.com