Fill and Sign the California 5th Appellate District Reverses an Award of Form

ADR-05 (05/03)REQUEST FOR REFERRAL/NON-REFERRAL TO THE PILOT PRISONER MEDIATION PANELUNITED STATES DISTRICT COURT CENTRAL DISTRICT OF CALIFORNIA REQUEST FOR REFERRAL/NON-REFERRAL TO THE PILOT PRISONER MEDIATION PANEL Case No.:Case Title: TO ALL PARTIES: The Court has established a Pilot Prisoner Mediation Panel. Certain prisoner civil rights and Bivens cases may be referred to a neutral member of this panel appointed by the Court for prisoner mediation proceedings. The proceedings will consist of one or more telephonic conferences as determined by the mediator. This Request for Referral will be reviewed only by the district or magistrate judge assigned to the case for the purpose of determining whether this matter is suitable for the Pilot Prisoner Mediation Panel. All requests will remain confidential. Please complete one of the following options: GI request that this case be referred to the Pilot Prisoner Mediation Panel. Please state the reasons why you believe that this case should be referred to the Panel. (This section must be completed in order for your request to be considered.) GI request that this case not be referred to the Pilot Prisoner Mediation Panel. Please state the reasons why you believe that this case should not be referred to the Panel. Please note that while the judge will consider the parties’ responses to this Request, the Court, on its own motion, may refer this case to the Pilot Prisoner Mediation Panel. Dated: By: DO NOT FILE THIS REQUEST WITH THE COURT. Mail this form to: Attorney Settlement Officer Panel Coordinator, United States Courthouse, Room G-8, 312 N. Spring Street, Los Angeles, California 90012.