Form AOC-MED-ADR-15 "Felony Mediation Confidential Report to Aoc for Data Purposes Only" - Kentucky

What Is Form AOC-MED-ADR-15?

This is a legal form that was released by the Kentucky Court of Justice - a government authority operating within Kentucky. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on April 1, 2021;
  • The latest edition provided by the Kentucky Court of Justice;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form AOC-MED-ADR-15 by clicking the link below or browse more documents and templates provided by the Kentucky Court of Justice.

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Download Form AOC-MED-ADR-15 "Felony Mediation Confidential Report to Aoc for Data Purposes Only" - Kentucky

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AOC-MED-ADR-15
Case No. ____________________
Rev. 4-21
Page 1 of 1
l e x
e t
Court ________________________
j u s t i t i a
Commonwealth of Kentucky
County ______________________
Court of Justice
www.kycourts.gov
FELONY MEDIATION
CONFIDENTIAL REPORT TO AOC FOR
Division ______________________
DATA PURPOSES ONLY
DO NOT FILE IN THE RECORD
Requesting Judge: ____________________________________________________
Name
Assigned Mediator: ____________________________________________________
Name
Case Name: ______________________________________
Date of Mediation: _________________________________
mm/dd/yyyy
The participants were:
_______________________________________
_______________________________________
Name
Name
_______________________________________
_______________________________________
Name
Name
_______________________________________
_______________________________________
Name
Name
Charges: _______________________________________________________________________________________
_______________________________________________________________________________________________
Mediation Result (settled/not settled) and Agreement Terms: ___________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Time Elapsed for Mediation: _________________________
Did victim(s) participate?: q Yes q No
If yes, what effect did the victim’s participation have on the process and/or on any of the other participants?
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Other: _________________________________________________________________________________________
_________________________________________________________________________________________.
__________________________, 2______
____________________________________________
Date
Mediator
DO NOT FILE IN THE RECORD
SUBMIT TO: AOC, Mediation Coordinator, 1001 Vandalay Drive, Frankfort, KY 40601; or felonymediation@kycourts.net.
Print
Reset Form
AOC-MED-ADR-15
Case No. ____________________
Rev. 4-21
Page 1 of 1
l e x
e t
Court ________________________
j u s t i t i a
Commonwealth of Kentucky
County ______________________
Court of Justice
www.kycourts.gov
FELONY MEDIATION
CONFIDENTIAL REPORT TO AOC FOR
Division ______________________
DATA PURPOSES ONLY
DO NOT FILE IN THE RECORD
Requesting Judge: ____________________________________________________
Name
Assigned Mediator: ____________________________________________________
Name
Case Name: ______________________________________
Date of Mediation: _________________________________
mm/dd/yyyy
The participants were:
_______________________________________
_______________________________________
Name
Name
_______________________________________
_______________________________________
Name
Name
_______________________________________
_______________________________________
Name
Name
Charges: _______________________________________________________________________________________
_______________________________________________________________________________________________
Mediation Result (settled/not settled) and Agreement Terms: ___________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Time Elapsed for Mediation: _________________________
Did victim(s) participate?: q Yes q No
If yes, what effect did the victim’s participation have on the process and/or on any of the other participants?
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Other: _________________________________________________________________________________________
_________________________________________________________________________________________.
__________________________, 2______
____________________________________________
Date
Mediator
DO NOT FILE IN THE RECORD
SUBMIT TO: AOC, Mediation Coordinator, 1001 Vandalay Drive, Frankfort, KY 40601; or felonymediation@kycourts.net.
Print
Reset Form