Form AOC-A-208 "Custody Mediation Intake Form" - North Carolina

What Is Form AOC-A-208?

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

Form Details:

  • Released on December 1, 2016;
  • The latest edition provided by the North Carolina Court System;
  • Easy to use and ready to print;
  • Available in Spanish;
  • 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-A-208 by clicking the link below or browse more documents and templates provided by the North Carolina Court System.

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Download Form AOC-A-208 "Custody Mediation Intake Form" - North Carolina

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STATE OF NORTH CAROLINA
CUSTODY MEDIATION INTAKE FORM
NORTH CAROLINA ADMINISTRATIVE OFFICE OF THE COURTS
Please complete both sides.
County Where Case Is Filed
Case File Number
CVD
Will you or the other party need an interpreter?
Yes
No
If yes, what language?
Today’s Date
Full Name
Date Of Birth
Mailing Address
City
State
Zip
Home Telephone No. (including area code)
Cell No. (including area code)
Email Address
Highest Level Of Education Completed
Employer
Work Telephone No. (including area code)
Are you currently employed?
Yes
No
Job Title
Work Schedule
Which is the best number for the mediator to reach you?
Home
Cell
Work
Other:
On which number(s) can the mediator leave a message?
Home
Cell
Work
Other:
Full Name Of The Other Party In This Dispute
Telephone No.
Email Address
The Other Party's Mailing Address
City
State
Zip
List the child(ren) in this custody dispute:
Child’s Full Name
Date Of Birth
Age
Grade
Gender
Child Lives With
What is your relationship with the child(ren) in this dispute?
(check one)
Biological Mother
Biological Father
Grandmother
Grandfather
Adoptive Mother
Adoptive Father
Other
Are children from other relationships living with you?
Yes
No
Sometimes
Are you and the other party currently living together?
Yes
No
Sometimes
Relationship status:
(check all that apply)
We never lived together.
We previously lived together.
We are married and separated.
We are divorced.
We were never married.
I am living with a new partner.
Other:
(please specify)
When did you stop living together?
(approximate date)
What are you hoping to achieve in mediation?
(Over)
AOC-A-208, Rev. 12/16
© 2016 Administrative Office of the Courts
STATE OF NORTH CAROLINA
CUSTODY MEDIATION INTAKE FORM
NORTH CAROLINA ADMINISTRATIVE OFFICE OF THE COURTS
Please complete both sides.
County Where Case Is Filed
Case File Number
CVD
Will you or the other party need an interpreter?
Yes
No
If yes, what language?
Today’s Date
Full Name
Date Of Birth
Mailing Address
City
State
Zip
Home Telephone No. (including area code)
Cell No. (including area code)
Email Address
Highest Level Of Education Completed
Employer
Work Telephone No. (including area code)
Are you currently employed?
Yes
No
Job Title
Work Schedule
Which is the best number for the mediator to reach you?
Home
Cell
Work
Other:
On which number(s) can the mediator leave a message?
Home
Cell
Work
Other:
Full Name Of The Other Party In This Dispute
Telephone No.
Email Address
The Other Party's Mailing Address
City
State
Zip
List the child(ren) in this custody dispute:
Child’s Full Name
Date Of Birth
Age
Grade
Gender
Child Lives With
What is your relationship with the child(ren) in this dispute?
(check one)
Biological Mother
Biological Father
Grandmother
Grandfather
Adoptive Mother
Adoptive Father
Other
Are children from other relationships living with you?
Yes
No
Sometimes
Are you and the other party currently living together?
Yes
No
Sometimes
Relationship status:
(check all that apply)
We never lived together.
We previously lived together.
We are married and separated.
We are divorced.
We were never married.
I am living with a new partner.
Other:
(please specify)
When did you stop living together?
(approximate date)
What are you hoping to achieve in mediation?
(Over)
AOC-A-208, Rev. 12/16
© 2016 Administrative Office of the Courts
Is there an existing order in place pertaining to custody (including one from another state, county, or juvenile court) that you are hoping to
revise or amend?
Yes
No
If yes, please provide details about the order (case number, county, state, etc.):
Everyone disagrees and argues with family and friends now and then. What happens when you and the other party involved in mediation
disagree or argue?
Is there a current or expired Domestic Violence Protective Order or other type of no-contact order between you and the other party?
Yes
No
If yes, what type of no-contact order and when does it expire?
Have there been any criminal cases involving you and the other party?
Yes
No
If yes, what type? (e.g., trespassing, assault, etc.)
What was the outcome? (e.g., dismissal, acquittal, guilty)
Has Child Protective Services ever investigated the safety of your children?
Yes
No
If yes, what date(s) did the investigation begin and end?
I fear for my safety around the other party.
Yes
No
I fear for my children’s safety with the other party.
Yes
No
I have concerns about the other party’s drug/alcohol abuse.
Yes
No
If yes to any of the above, please describe:
Has the other party threatened you with a weapon?
Yes
No
If yes, what happened as a result?
Has the other party threatened to hurt:
you
himself/herself
the children
a family pet?
No threats were made.
If threatened, what happened as a result?
Has the other party been violent towards you?
Yes
No
If yes, what happened as a result?
Fill in this section completely.
For the six (6) months before this action was filed:
The plaintiff lived in (name of state)
The defendant lived in (name of state)
The child(ren) lived in (name of state)
Name Of Attorney Of Record
Mailing Address
City
State
Zip
Attorney’s Telephone No. (including area code)
Attorney’s Fax No. (including area code)
AOC-A-208, Side Two, Rev. 12/16
© 2016 Administrative Office of the Courts
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