Mediator Feedback Form - Office for Dispute Resolution

Mediation Date*

File Number*

Mediator*

Mediation Location

In-person
Virtual (with video) via Zoom
Audio only via Zoom
Audio only via conference call

Were the issues in the mediation the same as the issues listed in the assignment email?

Yes
No

If no, please list the issues in the mediation here.

Mediation Outcome

Agreement
No Agreement

If the mediation resulted in a signed mediation agreement, did the agreement address all or some of the issues discussed at mediation?

All
Most
Some

If the mediation resulted in a signed mediation agreement, please indicate how the agreement was signed.

physical signature in person
electronic signature program (DocuSign)

If the mediation did not result in an agreement, please explain why you think there was not a signed agreement.

Additional comments about the mediation agreement:

Time Spent

Did you contact the parties prior to the mediation session?

Yes
No
Attempted but unable to contact

If yes, how much time was spent with the parties?

Additional Preparation Time

Travel Time

Session Length

Mediator Feedback

Was the environment (physical or virtual) suitable for the mediation session?

Yes
No

If no, please explain.

Was your understanding of the special education topics and regulations adequate for the discussions that took place during this mediation? (This question is for ODR to identify training needs.)

Yes
No

If no, please describe below what content area(s) you would like more information on. Please include specific questions.

Are there any additional topics you would like information on, or specific questions that you have, based on this mediation?

Additional comments: