Free Mediator Report Form - Vermont

STATE OF VERMONT ENVIRONMENTAL COURT
Docket No.:
Case Name

Vtec

ALTERNATIVE DISPUTE RESOLUTION REPORT
Report due from mediator within 15 days of completion of mediation

Date of ADR Session 1.

Starting Time

Finishing Time

Please indicate the names and addresses of all persons participating in the ADR Session. (If additional space is needed, please attach an additional sheet.) If any party is a corporation or other entity, please indicate the name and title of the representative. Identify with an asterisk the representative of each party who had decision-making authority.

Name
Appellant/Plaintiff

Representative & Title If Applicable

Mailing Address

City, State & Zip Code

Appellant/Plaintiff's Counsel

Appellee/Defendant

Appellee/Defendant's Counsel

Municipality/State

Municipality/State's Counsel

Interested Parties/Other

2.

Were all appropriate parties in attendance? If not, who failed to appear? substitute arrangement made regarding attendance at the ADR Session.

Please summarize any

3.

Was full or partial settlement reached at the session? parties.

If so, please summarize and append any agreement of the

________________________________________________________________________________________________

________________________________________________________________________________________________

________________________________________________________________________________________________

Mediator

Date