Mediation Request FormRequest MediationContact InformationFull NamePhone NumberEmailAddressStreet AddressApartment/UnitCityStateZip CodeCase InformationWhat type of case do you need mediation for?selectFamily (including divorce)Civil Issue over $30,000Civil Issue under $30,000ProbateEvictionEducationalDependency (child/edler care)Case Number (if already assigned)Where you court-ordered by a judge to attend mediation?selectYesNoDateAttorney InformationAre you currently represented by an attorney?selectYesNoName of attorneyAttorney's Phone NumberAttorney's EmailOther Party's InformationName of the other person/businessOther person/business phone numberOther person/business emailOther person/business addressAdditional contact information for other partyIs the other person/business currently represented by an attorney?selectYesNoNot SureName of other attorneyPhone number of other attorneyEmail of other attorneyInterpreter InformationDo you need an interpreter for mediation?selectYesNoWhat language do you need interpreted?selectSpanishSwahiliKinyarwandaMandarinArabicFilipinoTagalogCebuano (Bisaya)Will the other person/business need an interpreter?selectYesNoNot SureWhat language do they need interpreted?selectSpanishSwahiliKinyarwandaMandarinArabicFilipinoTagalogCebuano (Bisaya)Additional InformationIs there anything else you would like us to know about the circumstances or case?How did you hear about AEP Mediation?selectGoogleSocial MediaThumbtackBarkNextdoorMediate.comAttorney/Law FirmFamily/FriendOtherWhich social platform?How did you hear about AEP?Who recommended AEP?Which attorney or law office?Submit Request
