Free IN THE SUPERIOR COURT FOR THE STATE OF ALASKA - Alaska


File Size: 385.8 kB
Pages: 1
Date: February 12, 2007
File Format: PDF
State: Alaska
Category: Court Forms - State
Author: Hernandez
Word Count: 190 Words, 1,152 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.state.ak.us/courts/forms/med-200.pdf

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IN THE SUPERIOR COURT FOR THE STATE OF ALASKA AT In the Matter of DOB: DOB: DOB: DOB:
Minors Under the Age of Eighteen (18) Years

) ) ) ) ) ) ) ) )

CASE NO.

REQUEST FOR COURT SPONSORED CINA MEDIATION or FAMILY GROUP CONFERENCING (FGC) Mediation FGC I am requesting a referral for: OCS Worker AAG GAL Mother (or attorney) Father (or attorney) I am: Tribal Representative Indian Custodian (or attorney) Other legal party I have consulted with all other legal parties and we all agree to make this referral (not required). Other legal parties are listed below. In addition, I may list other persons who should participate. NOTE: If you need to add more names, please attach an additional sheet. Name Relationship Phone(s) and Email address

I think mediation/FGC should focus on the following areas or issues of concern:

Date
I certify that on a copy of this request was sent to: Mother Father OCS Indian Custodian AAG GAL PD Tribe CASA Other Dispute Resolution Coordinator, Karen Largent By:

Signature Type or Print Name Mailing Address City State ZIP

Contact Telephone Number(s)

MED-200 (2/07)(cs) REQUEST FOR COURT SPONSORED CINA MEDIATION/FGC