THE STATE OF NEW HAMPSHIRE
Court Name: Case Name: Case Number:
1. Name of Mediator: 2. Date of Mediation Session: 3. Periodic Mediation Report: Parties have rescheduled mediation to the following date and time: Parties have agreed to ongoing mediation, and do not request a hearing at this time. The next mediation date is: Parties have agreed to ongoing mediation, with the next mediation session on the following date and time: they ask the court to schedule the next event at this time. 4. Final Mediation Report: Mediation session ended due to disagreement over attorney or third party participation. Case settled prior to mediation session. Case may be appropriate for mediation but not with this mediator due to a conflict of interest or incompatibility between mediator's strengths/style and parties' needs. Case tentatively settled during mediation session. Parties were encouraged to seek legal review. A written agreement, covering all essential issues signed by the parties: is attached will be submitted to the court within 30 days days upon review/input of parties' counsel. will be submitted within 45 . However,
Case settled in part. Parties were encouraged to seek legal review. A written partial agreement, covering essential issues and signed by the parties: is attached OR will be submitted to the court within 30 days. The following issues were not resolved:
a Temporary Hearing, as sought in the initial pleadings, on the remaining The parties request issues or a Scheduling Conference prior to a Final Hearing. Case did not settle; court to schedule next hearing. The following parties failed to appear: I hereby certify that a copy of this report was mailed/given to the following attorneys of record and/or pro se parties:
Please file this form at the Court within 3 days of the mediation session.
NHJB-2324-F (04/08/2008) Page 1 of 1
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