Evaluation: Mediation

Mediation Evaluation

Please fill out the form below.

* indicates a required field

File Number:



Mediation Date:


Thank you for participating in the mediation process. We ask that you take a few minutes to complete this

evaluation as it is important for the Office for Dispute Resolution (ODR) to receive your feedback.

Mediation Evaluation Questionnaire

1. With regard to ODR, please indicate your satisfaction with the staff explaining the mediation procedures,

contacting the parties and scheduling the mediation


Now think about the mediator in your case. Check a response which represents your opinion about the following


2.Did the mediator explain
the mediation process
his/her role in mediation
each party’s role in mediation

3.Did the mediator
listen to your concerns
understand the issues
treat you with respect
help you clarify and prioritize your concern

4.Did the mediator foster an environment where
ideas and concerns could be shared
mutual respect and understanding were encouraged
the parties could work together to develop solutions
anger and tension could be expressed constructively

5.If the parties had difficulty developing solutions, did the mediator help the parties
move past serious differences
clarify information
problem solve

6.Is an IEP, IFSP or service agreement meeting scheduled to accommodate any changes resulting from the mediation



7.Would you contact ODR and request mediation services for any future special education disputes?

8.As a result of this mediation, do you feel that you have established better communication with the other party, a

better understanding of their concerns, and be able to discuss issues more openly and constructively in the future?


9.Overall, how satisfied were you with the results of mediation?

10.Do you have any suggestions on ways to improve mediation?

Name (Optional):


Please provide any suggestions for improvement of the mediation system.

If you would like a representative from ODR to contact you to discuss this evaluation, please provide your name and contact information.