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FORM B. REQUEST FOR ADDITIONAL MEDIATION SESSIONS

Effective Date: 1/1/2001

STATE OF NORTH DAKOTA IN DISTRICT COURT

COUNTY OF __________________ ___________________JUDICIAL DISTRICT

A.B,
Plaintiff,

vs.

C.D.,
Defendant

 )
)
)
)		 FAMILY MEDIATION PROGRAM
REQUEST FOR ADDITIONAL MEDIATION SERVICES

The following party/parties makes the following request for additional mediation sessions:

Names: ___________________________________________________

a) Reasons for additional sessions:

Number of additional sessions requested: ___________________

Proposed date for completion of mediation: ___________________

b) The mediator in this case (name) _________________ agrees that additional mediation sessions are warranted for the above-stated reasons:

Signature: ________________________ Date: ______________

Decision: The family mediation program administrator ___ denies ____ grants addition sessions as requested above. If granted, all mediation must be completed by the following date: _______________________________.

Signature ________________________ Date _________________________
(Family mediation program administrator)

cc: Judge ______________, Parties/Attorneys, Mediator

Effective Date Obsolete Date
01/01/2001 View