Fill out the form below to begin the process of resolving your dispute.Fees are negotiated between participants and mediators. Please fill out your basic information: First Name: (Required) Last Name: (R) Phone: Email: (R) Business Name (if applicable): If you do not wish for the mediator to contact the other party please leave this section blank. Please fill out the other party's basic information: First Name: Last Name: Phone: Email: Business Name (if applicable): Are there other parties involved in this dispute? If so, list email addresses of other parties (one per line): Please fill out these dispute details: Nature of the dispute: Adoption Americans w/Disabilities Act Art Business Civil (general) Commercial Community Construction Contracts Criminal Cross Cultural Divorce (all issues) Divorce (parenting) Education EEOC Employment Engineering Environmental Family (other) Franchise General Insurance International Labor Management Land Use Landlord - Tenant Legal Malpractice Lesbian, Gay, Bi & Trans Issues Medical Native American Indian Disputes Online Mediation and Facilitation Organizational Partnership Dissolutions Police Postal Service Probate Professional Fee Disputes Public Policy Real Estate Religious / Church Securities Social Security Special Education Tax Technology Torts Victim Offender Mediation Work Place Worker's Comp What date did this dispute begin? January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2018 2019 2020 2021 2022 2023 2024 What is the approximate monetary value of the items under dispute? Less than $5,000 Less than $10,000 Less than $25,000 Less than $50,000 Less than $100,000 Over $100,000 Over $250,000 This dispute is regarding... (R) What do you and the other party disagree about? (R) Are there any things you and the other party might agree upon? What has happened so far in this dispute? (phone calls, emails, etc.) What do you want to get from this mediation? (R) Please add anything else you think it would be helpful for a mediator to know:
