Free Mediation Case Information Form for Mediation of Economic Aspects of Family Law Cases - New Jersey

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State of New Jersey

For Office Use Only Date Received: Date Entered:

MEDIATION CASE INFORMATION FORM
For Mediation of Economic Aspects of Family Law Cases

Directions: This form is to be completed by the mediator when mediation is concluded or the case is returned to court.
CASE DOCKET NUMBER CASE NAME NAME OF MEDIATOR

OUTCOME mediation held / full agreement on all issues mediation held / some issues still pending mediation held / no agreement no mediation held / parties settled case before mediation session no mediation held / party failed to attend
DATE CASE ASSIGNED TO MEDIATOR DATE OF INITIAL MEDIATION SESSION DATE OF FINAL MEDIATION SESSION

NUMBER OF MEDIATION SESSIONS

NUMBER OF HOURS FOR PREPARATION

NUMBER OF MEDIATION HOURS

DID THE ATTORNEYS/PARTIES SUBMIT PROPER CASE SUMMARIES?

WERE THE ATTORNEYS/PARTIES PREPARED FOR THE MEDIATION SESSIONS?

DID THE PARTIES PARTICIPATE IN THE MEDIATION SESSIONS?

yes

no

yes

no
OR FAX TO:

yes

no

PLEASE RETURN TO: FAMILY DIVISION

Revised 02/01/2007, CN 10491-English

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