Mediator Report Form SubmissionPlease enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.NameFirstLastContract ID#Enter full contract ID number hereCase Typeex. Divorce, Upper Civil, Lower Civil, etc.Case InformationCase Number or Party NamesCase LeadMy LeadAEP LeadDate of MediationDate heldTime Slot/s (for this case only)8:00-10:0010:00-12:001:00-3:003:00-5:00OtherPayment ChoiceMail Check (10 business days)Zelle (same day payment) Type Slot/s Contract Payment InformationPlease add Mailing information or Zelle account you would like payment sent to.Mediator Feedback/Summary *Please add conclusion, issues, and/or any other feedback you think may be useful for us to know. (if parties are rescheduling, add requested date and time)Submit
