Get Coweta Circuit Adr Form

Mediation Initiation Form COWETA JUDICIAL CIRCUIT ADR PROGRAM The Mediation Center 100 Ridley Avenue Suite 2500 LaGrange GA 30240 Phone 706-883-2168/2170 Fax 706-883-2169/706-298-3732 Civil Action County Date Action Filed Complainant s Data Name Home Phone Bus. Phone Address Attorney s Name Bus. Phone Respondent s Data Case Information Type of action Divorce Modification of Alimony Custody Support Other Issue s to be mediated Child Custody Alimony Child Support Property Division Visitation Debt Division Will attorneys attend the mediation session Yes No Are there allegations of domestic violence or child abuse in this case Yes No Unknown Are there concerns about the use of mediation in this case because of any special circumstances or safety sues Yes No Unknown* Please feel free to contact this office by phone to discuss. is- Comments Special Instructions for Domestic Cases If children s issues are to be mediated both parties are required to attend the parent seminar prior to scheduling the case for mediation* If applicable provide the dates parties attended Complainant Respondent. If issues to be mediated include child support alimony division of property modification of alimony or support each party must furnish the mediator with a copy of their financial affidavit which has been filed with the Court U*S*C. R* 24. 2. Submitted by Form must indicate bar number and be signed Print Attorney Name and Bar Signature Date. Phone Address Attorney s Name Bus. Phone Respondent s Data Case Information Type of action Divorce Modification of Alimony Custody Support Other Issue s to be mediated Child Custody Alimony Child Support Property Division Visitation Debt Division Will attorneys attend the mediation session Yes No Are there allegations of domestic violence or child abuse in this case Yes No Unknown Are there concerns about the use of mediation in this case because of any special circumstances or safety sues Yes No Unknown* Please feel free to contact this office by phone to discuss. is- Comments Special Instructions for Domestic Cases If children s issues are to be mediated both parties are required to attend the parent seminar prior to scheduling the case for mediation* If applicable provide the dates parties attended Complainant Respondent. is- Comments Special Instructions for Domestic Cases If children s issues are to be mediated both parties are required to attend the parent seminar prior to scheduling the case for mediation* If applicable provide the dates parties attended Complainant Respondent. If issues to be mediated include child support alimony division of property modification of alimony or support each party must furnish the mediator with a copy of their financial affidavit which has been filed with the Court U*S*C. If issues to be mediated include child support alimony division of property modification of alimony or support each party must furnish the mediator with a copy of their financial affidavit which has been filed with the Court U*S*C. R* 24. 2. Submitted by Form must indicate bar number and be signed Print Attorney Name and Bar Signature Date.