MEDIATOR’S EVALUATION FORM

NAME OF CASE:______________________________________________________________
CASE #:______________________________________________________________________
TYPE OF CASE:_______________________________________________________________

My name is:___________________________________, and I was the mediator in the above-referenced case.      Date mediation held:_______________________________
Length of mediation:_______________________________
Total time for mediation:____________________________

1.	Appellant was/was not present/or available by telephone.

2.	Appellant’s counsel was/was not present/or available by telephone
If either not present, why?_________________________________________________________
______________________________________________________________________________

3.	Respondent was/was not present/or available by telephone.

4.	Respondent’s counsel was/was not present/or available by telephone
If either not present, why?_________________________________________________________
______________________________________________________________________________

5.	Both sides were/were not prepared to meaningfully discuss settlement of the case.  If not prepared, it was for these reasons: (DO NOT list facts of the case. List reasons such as: seriously disputed liability, pending motions, etc.) _________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

6.	Meaningful settlement negotiations did/did not take place.

7.	The case was settled/not settled.

8.	Other (specify): ______________________________________________________________________
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

PLEASE MAIL TO:
STATE BAR OF MONTANA
APPELLATE ADR PROJECT
PO BOX 577
HELENA, MT  59624-0577