Family Court Mediation Intake Form

Intake Form

NOTE: Mediation dates are scheduled on a first come, first served basis. Submitting this form is not confirmation of mediation. Once mediation is scheduled, you will receive a confirmation from UMC’s Mediation Coordinator

MM slash DD slash YYYY

Plaintiff Information

If Self-represented, use Plaintiff Contact information

Defendant Information

If Self-represented, use Defendant Contact information

If If applicable, Guardian ad Litem contact information

Contested Issues
Select all that apply
Any history of Domestic Violence?
Is there a need for a translator?
This field is for validation purposes and should be left unchanged.