Attorney Information Sheet
Attorney’s Information Sheet and Request For Mediation
Scheduled Date for Mediation: _________________, 19_____ at ________ o’clock ____ . m.
COURT/CAUSE NO.:___________________________________________________
STYLE:_______________________________________________________________
1. Names, addresses and telephone numbers of parties plaintiff (identify authorized representative, if known) and attorneys of record:_______________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________
2. Names, addresses and telephone numbers of parties defendant (identify authorized representatives, if known) and attorneys of record:_______________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________
3. Names, addresses and telephone numbers of other parties (please specify, “Intervenor,” etc.) (identify authorized representatives, if known) and attorneys of record: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________
4. The nature of the Plaintiff’s claims and the Defendant’s defenses and counterclaims.____________________________________________________________ ________________________________________________________________________________________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________
5. What relief is sought by the parties. _____________________________________ ________________________________________________________________________ ________________________________________________________________________
6. What are the primary disputed issues of law or fact in this case, from your perspective? _____________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________
7. What is the status of discovery (1) little or none; 2) some discovery done but substantially incomplete; 3) substantially complete or complete._____________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________
8. A. Do you have sufficient information to form a realistic settlement position? If not, what else is needed?:___________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________
B. What are the last offers of the parties?_________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________
O behalf of __________________, one of the parties in the above cause, the undersigned attorney of record requests that __________________, agree to act as mediator in the above case and, as attorney of record and on behalf of my client, agree to be bound by the “rule for mediation” provided by the mediator to me.
DATED THE _______ day of _______________, 19 _____.
RESPECTFULLY SUBMITTED,
____________________________ Attorney of Record
© 1996 The Mediation Center, Inc.
