OFFICE OF THE EXECUTIVE SECRETARY SUPREME COURT OF VIRGINIA MENTEE EVALUATION FORM Please use black ink so this document will be legible when scanned. (To be completed by mentor and returned to mentee within ten days following case completion.) Section I. Mentee & Case Information (Please type or print) Mentee Mediator: Mentor Mediator: Are you currently certified as a mentor for this court level? Co-Mediation Case # Date(s) of Mediation: 1 2 3 4 5 6 7 8 Yes Case Type: Certification Number: No GDC JDR CCC CCF Length of mediation: Please describe the nature of the case and major issues involved (e.g., multi-party, presence of counsel, custody/visitation/support, truancy). Note the challenges/problems the case presented. Section II: Mentee Skills Check the appropriate number for each item using the following rating scale: NA ­ Not Applicable 1 ­ Unacceptable 2 ­ Needs Improvement (Additional Development and/or Training Recommended) 3 ­ Satisfactory (Performed Adequately for Current Co-mediation) 4 ­ Highly Competent (Took Lead and Exceeded Expectations for Current Co-mediation) 5 ­ Excellent (Demonstrated a Professional Level of Mediator Skills) NA NA NA NA 1 1 1 1 2 2 2 2 3 3 3 3 4 4 4 4 5 5 5 5 A. Personal Qualities Appropriate dress and appearance.......................................................................................... Developed rapport and trust, and conveyed a positive outlook................................... Appeared confident and in control of emotions...................................................... Appeared sensitive to clients' physical and emotional comfort.................................. B. Introduction Provided welcome and opening comments......................................................... Explained mediation process.......................................................................... Clarified role of participants........................................................................... Established ground rules................................................................................ Covered Agreement to Mediate form................................................................. C. Information Sharing Engaged participation of clients....................................................................... Understood issues and empathized with feelings................................................... Accurately and briefly summarized information and concerns................................... Balanced time and focus between clients............................................................ NA NA NA NA NA NA NA NA NA 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 4 4 4 4 4 4 4 4 4 5 5 5 5 5 5 5 5 5 FORM ADR-1001 July 2011 1 American LegalNet, Inc. www.FormsWorkFlow.com D. Issue Clarification Asked appropriate questions.............................................................................. Identified interests, intentions, differences, limitations, and underlying problems............... Identified common ground................................................................................ Reframed statements and issues.......................................................................... NA NA NA NA 1 1 1 1 2 2 2 2 3 3 3 3 4 4 4 4 5 5 5 5 E. Generation of Options Organized and prioritized mediatable issues.......................................................... NA Focused on present and future needs rather than positions.......................................... NA Elicited multiple options and explored settlement possibilities..................................... NA F. Resolution/Closure Facilitated negotiation and bargaining................................................................. Assisted parties with reality testing..................................................................... Drafted agreement that is sufficiently specific and addressed all issues......................... Drafted agreement that is well organized, clearly stated, and easily readable................... Assisted in developing an agreement that is balanced, fair, realistic, understood, and not coerced..................................................................................................... Discussed options for noncompliance or resolving future conflict................................ Sufficient effort exerted to assist parties in reaching agreement................................... Provided appropriate information and referral....................................................... Completed child support worksheet by hand (if applicable)....................................... G. Professional Qualities Allowed adequate planning and preparation time ................................................... Possessed adequate knowledge of issues............................................................ Demonstrated an awareness of ethical issues........................................................ Maintained neutrality, impartiality, and objectivity................................................ Avoided giving advice, pressure, and judgment.................................................... Demonstrated respect for different values and lifestyles.......................................... Demonstrated ability to work with co-mediator and clients....................................... Engaged in ongoing assessment of appropriateness of case for mediation...................... H. Communication Skills Demonstrated appropriate posture, gestures, and eye contact..................................... Demonstrated appropriate use of voice, tone, volume, and clarity............................... Demonstrated appropriate verbal content and timing.............................................. Demonstrated appropriate listening styles and other intuitive abilities.......................... Demonstrated good paraphrasing and reframing skills............................................ NA NA NA NA NA NA NA NA NA 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 2 2 34 34 34 3 3 3 3 3 3 3 3 3 4 4 4 4 4 4 4 4 4 5 5 5 5 5 5 5 5 5 5 5 5 NA NA NA NA NA NA NA NA NA NA NA NA NA 1 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 3 3 4 4 4 4 4 4 4 4 4 4 4 4 4 5 5 5 5 5 5 5 5 5 5 5 5 5 FORM ADR-1001 July 2011 2 American LegalNet, Inc. www.FormsWorkFlow.com I. Special Techniques Demonstrated appropriate use of caucus................................................... Demonstrated appropriate involvement of other pa