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STATE OF ILLINOIS
IN THE CIRCUIT COURT OF THE 17th JUDICIAL CIRCUIT COUNTY OF BOONE WINNEBAGO
BOONE
WINNEBAGO
CC-262 V4
FILE STAMP
PETITIONER/PLAINTIFF,
v.
Case No.
RESPONDENT/DEFENDANT.
PETITIONER/PLAINTIFF,
Case No.
RESPONDENT/DEFENDANT. )
MEDIATOR REPORT
☐I mediated with ___, and ___.
and
I mediated with
undefined
☐ I scheduled meetings on _____.
I scheduled meetings on
undefined
□I met with them on _____ for a total time of _____. (00.00)
I met with them on
for a total time of
undefined
□Prior to and during mediation, I screened the case for eligibility pursuant to Local Rule 14.08 Rule 6 on safety protocols, and determined that the matter □ was □ was not eligible.
Prior to and during mediation, I screened the case for eligibility pursuant to Local Rule
was
was not eligible
□No mediation occurred because a prior agreement resolving all issues was reached.
No mediation occurred because a prior agreement resolving all issues was reached
□No mediation occurred because _____ failed to: □ contact the mediator to schedule mediation □ appear for a scheduled mediation □ pay the mediator.
No mediation occurred because
mediator to schedule mediation
contact the
appear for a scheduled mediation
pay the mediator
□One or both the parties has/have not completed the parent education program as required by Local Rule 14.08(2)(B).
One or both the parties has/have not completed the parent education program as
□ No mediation occurred because one or both parties has indicated a change in financial circumstances since ordered to mediation, and the case is being sent to court for clarification
No mediation occurred because one or both parties has indicated a change in financial
A. The mediation has now concluded because:
☐The parties have reached an agreement as to all disputed issues.
The parties have reached an agreement as to all disputed issues
□The parties have reached an agreement as to some of the issues and are at an impasse in regard to the remaining issues.
The parties have reached an agreement as to some of the issues and are at an
Pursuant to local rule, the mediation has been terminated by the mediator.
Pursuant to local rule, the mediation has been terminated by the mediator
B. The appointment of a Child Representative or Guardian ad Litem □ is □ is not recommended in accordance with Local Rule 14.08(8)(H).
is
is not
C. □Mediation continues with the next session scheduled on _____ and it is anticipated that an additional _____ days will be needed to complete the process.
Mediation continues with the next session scheduled on
C
and it is anticipated that an additional
DATE:___
DATE
NAME:___
NAME
ADDRESS:___
SIGNED:___
ADDRESS
PHONE:___
PHONE
SIGNED:
SIGNED
BB