"Statistical Reporting Form for Court Ordered Mediation" - Arkansas

Statistical Reporting Form for Court Ordered Mediation is a legal document that was released by the Arkansas Judiciary - a government authority operating within Arkansas.

Form Details:

  • Released on January 1, 2016;
  • The latest edition currently provided by the Arkansas Judiciary;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Arkansas Judiciary.

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Download "Statistical Reporting Form for Court Ordered Mediation" - Arkansas

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Arkansas Alternative Dispute Resolution Commission
Statistical Reporting Form for Court Ordered Mediation
Please complete this form for all court ordered mediations. If a referral fails to attend mediation, fill in as much information
as possible in order for the Commission to compile accurate statistics.
MEDIATOR INFORMATION
Last
First
M.I.
Certification Number
City
State
Zip
Phone
FILING INFORMATION
County
Judge
Circuit #
Docket # (Include subject prefix, i.e. JV, DR, PR,CV)
Plaintiff’s Name
Defendant’s Name
Date Mediation was ordered
(please check one):
JUVENILE
DOMESTIC RELATIONS
PROBATE
CIVIL
Division
Is this case an Arkansas Access & Visitation Mediation Program Case?
YES
NO
MEDIATION ISSUES
Case Type: Please check all that apply. For “Other” categories, please describe case characteristics.
1.
Motor Vehicle Negligence
8.
Decedent Estates
16.
Separate Maintenance
2.
Other Negligence
9.
Trust Administration
17.
Domestic Abuse
3.
Malpractice
10.
Guardianship
18.
Families in Need of Services
4.
Product Liability
11.
Adoption
19.
Juvenile Delinquency
5.
Contracts (Please specify
12.
Divorce
20.
Dependency Neglect
type): _______________
13.
Paternity
21.
Termination of Parental Rights
6.
Equity
14.
Custody/Visitation
22.
Extended Juvenile Jurisdiction
7.
Partnership
15.
Child Support
23.
Other: __________________
MEDIATION SESSION(S)
1. Did the mediation take place?
A.
No, mediation never began.
B.
Yes, but mediation was halted, returned to court without agreement on
/
/
.
C.
/
/
Yes, mediation was completed on
with a full agreement.
D.
/
/
Yes, mediation was completed on
with a partial agreement.
E.
No agreement reached on
/
/
.
2. Did the judge send all issues of the case to mediation or limited issues of the case?
All Issues
Limited Issues
3. How many mediation sessions were conducted?
4. How many TOTAL hours were spent in mediation?
Please complete and return to:
Arkansas Alternative Dispute Resolution Commission
Administrative Office of the Courts
625 Marshall Street
Little Rock, AR 72201
FAX: (501) 682-9410
Rev. 01/16
Arkansas Alternative Dispute Resolution Commission
Statistical Reporting Form for Court Ordered Mediation
Please complete this form for all court ordered mediations. If a referral fails to attend mediation, fill in as much information
as possible in order for the Commission to compile accurate statistics.
MEDIATOR INFORMATION
Last
First
M.I.
Certification Number
City
State
Zip
Phone
FILING INFORMATION
County
Judge
Circuit #
Docket # (Include subject prefix, i.e. JV, DR, PR,CV)
Plaintiff’s Name
Defendant’s Name
Date Mediation was ordered
(please check one):
JUVENILE
DOMESTIC RELATIONS
PROBATE
CIVIL
Division
Is this case an Arkansas Access & Visitation Mediation Program Case?
YES
NO
MEDIATION ISSUES
Case Type: Please check all that apply. For “Other” categories, please describe case characteristics.
1.
Motor Vehicle Negligence
8.
Decedent Estates
16.
Separate Maintenance
2.
Other Negligence
9.
Trust Administration
17.
Domestic Abuse
3.
Malpractice
10.
Guardianship
18.
Families in Need of Services
4.
Product Liability
11.
Adoption
19.
Juvenile Delinquency
5.
Contracts (Please specify
12.
Divorce
20.
Dependency Neglect
type): _______________
13.
Paternity
21.
Termination of Parental Rights
6.
Equity
14.
Custody/Visitation
22.
Extended Juvenile Jurisdiction
7.
Partnership
15.
Child Support
23.
Other: __________________
MEDIATION SESSION(S)
1. Did the mediation take place?
A.
No, mediation never began.
B.
Yes, but mediation was halted, returned to court without agreement on
/
/
.
C.
/
/
Yes, mediation was completed on
with a full agreement.
D.
/
/
Yes, mediation was completed on
with a partial agreement.
E.
No agreement reached on
/
/
.
2. Did the judge send all issues of the case to mediation or limited issues of the case?
All Issues
Limited Issues
3. How many mediation sessions were conducted?
4. How many TOTAL hours were spent in mediation?
Please complete and return to:
Arkansas Alternative Dispute Resolution Commission
Administrative Office of the Courts
625 Marshall Street
Little Rock, AR 72201
FAX: (501) 682-9410
Rev. 01/16