Fill and Sign the Litigant Questionnaire Form

State of New Jersey LITIGANT QUESTIONNAIRE Statewide Civil, General Equity and Probate Mediation Program FOR OFFICE USE ONLY DATE RECEIVED: DATE ENTERED – AOC: DIRECTIONS: This form is to be completed by the litig ant at the conclusion of mediation. CASE DOCKET NUMBER COUNTY DID YOU PARTICIPATE IN MEDIATION AS OR ON BEHALF OF THE PLAINTIFF OR DEFENDANT? plaintiff defendant T HE MEDIATOR FOR THIS CASE WAS SELECTED BY: parties/attorneys court/judge DID YOU HAVE FULL AUTHORITY TO ENTER INTO A SETTLEMENT IN THE MEDIATION OF THE CASE? yes no DO YOU THINK THE MEDIATOR IN THIS CASE: yes no Gave you a full opportunity to convey your interests? yes no Was knowledgeable about the law relative to this case? yes no Was impartial? yes no Understood the issues in this case? WHAT IMPACT DID MEDIATION HAVE ON THIS CASE? Settled the case Moved the case significantly toward settlement Added unnecessary steps Settled some of the issues Clarified positions Increased tension Other: DID YOU FEEL PRESSURED TO REACH AN AGREEMENT IN MEDIATION: no yes, by the mediator yes, by the other side yes, by time or money constraints DO YOU THINK MEDIATION IN THIS CASE SAVED YOU MONEY? yes no DO YOU THINK MEDIATION IN THIS CASE SAVED TIME? yes no WOULD YOU RECOMMEND MEDIATION TO A FRIEND? yes no PLEASE USE THIS SPACE TO ADD ANY OTHER COMM ENTS ABOUT YOUR EXPERIENCE IN MEDIATION: PLEASE RETURN TO: AOC - CIVIL PRACTICE DIVISION BOX 981 TRENTON, NJ 08625 FAX: 609 777-0844 Revised 6/21/2005, CN 10525-english page 1 of 1