PA 412 Unit 4 Assignment

Unit Four Assignment

 

PA 412

MEDIATION INTAKE FORM

The goal of all mediations is to resolve the dispute in a way both parties are satisfied. (Frey, 2003) In order to do so, information about the dispute is needed and this form serves that purpose. Please answer the questions below to the best of your ability. None of the information provided will be given to any third party.

1) Date.

2) Full legal name.

3) Date of birth.

4) Social Security Number.

5) Address.

6) Gender

7) Phone number.

8) Email.

9) Reason for consolation.

10) Name of opposing party.

11) Phone number for this party.

12) Address for this party.

13) Please describe, in detail, the nature of the dispute.

14) Why do you think mediation will help settle this dispute?

15) What is your goal in mediation?

16) What is the history of the relationship between you and the other party?

17) During this history, has there ever been an incident involving any forms of violence?

18) Are you willing to listen and negotiate with the other party?

19) If your goal is not obtained in mediation, will you seek remedy through other legal forms?

20) If your goal is obtained though mediation but the other parties is not, are you willing to try another form of alternate dispute resolution?

21) Can you ever see yourself and the opposing party having a normal relationship again?

22) How do you plan on paying for the mediation and its associated cost?

23) Please provide all documents and evidence that you possess and plan on using during mediation.

24) Are you currently employed? If so, where and how long?

25) Would you prefer a one on one meeting with the mediator before mediation begins or would you rather just jump straight into this process?

26) Please describe your personality.

27) Please describe the opposing partiesโ€™ personality.

28) How does emotions affect you?

29) Has this dispute been discussed between you and the other party?

30) If so, what was the outcome of this conversation?

31) What is your understanding of the mediation process?

32) Has there been any contracts made between you and the other party?

33) Do you plan on bringing someone else with you to the mediation?

34) If so, please give their name and relationship to you.

35) What are your expectations regarding the role of the mediator?

36) Have you ever been involved in a mediation before?

37) If so, what happened in that situation?

38) Have you ever brought forth a lawsuit against another party?

39) Do you understand that mediation is voluntary and not legally binding?

40) Has this dispute had an impact on your loved ones? If so, how?

Below, please provide any additional information that you feel is important/relevant to your case.

Frey, A. M. (2003) Alternative Methods of Dispute Resolution. Retrieved from https://purdueuniversityglobal.vitalsource.com/#/books/1111505209/cfi/6/2!/4/2@0:0

Green, S. (2019) Creating an effective client intake form. Retrieved from https://www.practiceignition.com/blog/client-intake-forms

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