Free Mediation Questionnaire - Nebraska


File Size: 264.4 kB
Pages: 2
Date: December 30, 2008
File Format: PDF
State: Nebraska
Category: Divorce
Author: NHJB
Word Count: 425 Words, 2,851 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.courts.state.nh.us/forms/nhjb-2091-fs.pdf

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THE STATE OF NEW HAMPSHIRE

JUDICIAL BRANCH

http://www.courts.state.nh.us

Court Name: Case Name: Case Number:
(if known)

MEDIATION QUESTIONNAIRE
MEDIATOR DATE OF MEDIATION I am: { Petitioner { Attorney for Petitioner Strongly Agree { { { { { { { { { { { Respondent { Attorney for Respondent Agree Not Sure { { { { { { { { { { Disagree Strongly Disagree { { { { { { { { { {

Please fill in the circle z that best reflects your opinion of the mediator's performance in each area 1. The mediator explained the mediation process clearly so that I knew what to expect during the mediation session. 2. The mediator was impartial and treated all parties equally. 3. The mediator gave me an opportunity to fully explain the dispute. 4. The mediator listened to and understood my perspectives. 5. The mediator was able to facilitate discussion successfully. 6. The mediator helped us explore different options to resolve the dispute. 7. Mediation saved time and/or money in this case. 8 Overall, I was satisfied with the way the mediator handled the case and the mediation process. 9. I would consider mediation for other matters. 10. I would use this mediator again or recommend him or her to others.

{ { { { { { { { { {

{ { { { { { { { { {

11.

Mediation had the following impact on this case: (Fill all that apply.) { settled the case { settled some of the issues { significantly moved the case toward settlement { other { clarified positions of the parties { no impact

12.

At what stage in the case did the mediation session take place? (Fill all that apply.) { before any formal court hearing { after a Temporary Hearing { after a Preliminary Hearing { after several hearings { after the Final Pretrial Conference { unsure
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NHJB-2091-FS (04/24/2006)

Case Name:
Case Number:
MEDIATION QUESTIONNAIRE


13.

I feel the case was referred to mediation: { too early { at about the right time { too late

14.

If the mediation was not successful, which of the following reasons best explains why? { petitioner failed to participate { respondent failed to participate { mediator not helpful { mediation too late in process { other { lack of trust in other party { attorney advice to resist resolution { domestic violence past or present { mediation too early in process

15.

What did the mediator do well during your mediation session?

What could the mediator have done better during the mediation session?

16.

What do you like about the mediation program?

How would you change the mediation program?

17.

If you chose not to obtain legal representation, did the mediator advise you that an independent attorney should review your agreement before it is signed?

Please place questionnaire in sealed envelope and give to mediator to
be returned to court staff

NHJB-2091-FS (04/24/2006) Page 2 of 2

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