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Mediation and Arbitration - Forms

Supreme Court Mediation Forms

Form Number
Name of Form
Description
Associated Forms
NHJB-2614-SUP
(09/03/2009)
To be sent by Supreme Court to parties to appeal and completed by parties if they request mediation.
 
NHJB-2615-SUP
(11/012011)
Appellate Mediation Program Party Information Form
This form is completed by each party participating in appellate mediation. The information is provided only to the mediator assigned to the NH Supreme Court case.  
NHJB-2616-SUP
(11/01/2011)
Party Confidential Mediation Statement
Each party in a case referred to appellate mediation by the related NH Supreme Court order completes this form and submits to the office of mediation & arbitration.  
NHJB-2769-SUP
(08/17/2012)
Appellate Mediation Program Billing Statement This form was created for appellate mediators so that billing can be tracked and completed more easily by Accounting.  
NNHJB-2629-SUP
(10/30/2009)
This form is for Appellate Mediators, so that the mediator can report to the Supreme Court, whether the case settled or if it should be returned to the docket.
 

Superior Court Mediation Forms

Form Number
Name of Form
Description
Associated Forms
NHJB-2488-S
(03/25/2013)
The Neutral advises the court of the outcome of the mediation session. This form should be filed immediately following the mediation, but no later than 30 days before the scheduled trial date. If the mediation is successful, parties will file a copy of their agreement and further hearings or the trial, will be cancelled. If mediation is not successful, hearings or the trial will occur as originally scheduled.
 
NHJB-2490-S
(10/01/2013)
This form is used at the beginning of the ADR session. Copies are given to the parties, but no copy is filed with the court.
 
NHJB-2700-S
(10/01/2013)
Case Structuring and ADR Order Form is used by the plaintiff and/or defendant in a civil action when a structuring conference order is required under Superior Court Rule 5.  
NHJB-2091-DFPS
(08/20/2014)
Mediation Questionnaire Circuit Court divisions and Superior Court mediators will give the form to the parties after mediation, so they may complete and return to the clerk’s office in a sealed envelope.  

District Division Mediation Forms

Form Number
Name of Form
Description
Associated Forms
NHJB-2349-D
(07/01/2011)
Agreement to Mediate / Reporting Form
This form is signed by the mediator and parties; Used in District Court Small Claims mediation
 
NHJB-2623-D
(01/01/2010)
This form is completed reviewed by the mediator with the parties and counsel, if any, at the beginning of the mediation. The form is also used to report the results of the mediation to the Court.
 
NHJB-2625-D
(01/01/2010)
This form will be used by the mediator at the beginning of the mediation session to explain the process to the parties and counsel, if any. It will also be used to report the results of the mediation to the Court.
 
NHJB-2091-DFPS
(08/20/2014)
Mediation Questionnaire Circuit Court divisions and Superior Court mediators will give the form to the parties after mediation, so they may complete and return to the clerk’s office in a sealed envelope.  
NHJB-2630-D
(01/01/2010)
This form is required for all small claim and civil writ cases in which a mediation occurred. Mediators must submit bill for services in order to be paid.
 
NHJB-2262-DFS
(12/15/2006)
Statement for Services other than Counsel
Statement itemizing the duration and cost of services other than counsel provided to a party by a person or association, after such services have been approved for payment by the court.
 

Probate Division Mediation Forms

Form Number
Name of Form
Description
Associated Forms
NHJB-2154-P
(03/30/2010)
Statement for Payment Instructions
NHJB-2091-DFPS
(08/20/2014)
Mediation Questionnaire Circuit Court divisions and Superior Court mediators will give the form to the parties after mediation, so they may complete and return to the clerk’s office in a sealed envelope.  
NHJB-2180-P
(07/0/2011)
To be completed by the mediator at the end of a mediation session to notify the court of the outcome of the mediation. This form is used internally but posted on the website so those participating in mediation may review it ahead of time and better understand the mediation process.
 

Family Division Mediation Forms

Form Number
Name of Form
Description
Associated Forms
NHJB-2392-F
(12/07/2006)
Adoption Mediation Report
This form is completed by the probate mediator following the voluntary mediated adoption session. The form guides the court in scheduling the next event in the case.
 
NHJB-2712-F
(03/25/2013)

Assented to Motion to Exceed $300 Mediation Fee in a Fund Case

 

Form completed by parties and mediator at, approximately, the 3 hour mark during mediation process if the matter appears to need more than 5 hours of mediation time and if the parties agree. Mediator will file at the request of the parties.
 
NHJB-2087-F
(08/20/2014)
Have you considered mediation?
Distributed to parties with Order of Notice, explaining mediation.
 
NHJB-2412-F
(07/01/2011)
Important Information for Attorneys
This form is used to provide important information to attorneys who represent parties to divorce, legal separation, civil union dissolution, or parenting actions in the Family Division.
 
NHJB-2680-FS
(01/01/2013)
Important Information Regarding Mediation Fees
Information sheet for parents in divorce/parenting cases regarding fees for mediation with court contracted mediators explaining the set fee and sliding scale fee set forth in modification to Supreme Court Rule 48-B (effective 10/1/2010)
 
NHJB-2325-FS
(01/01/2013)
Important Mediation Information
This form is given to parties, at First Appearance, along with their date for mediation, as a reminder of payment and other issues.
 
NHJB-2386-F
(12/27/2007)
Mediation Chart
Distributed to parties at First Appearance, showing case flow process.
 
NHJB-2752-FS
(01/01/2013)
Mediation Grant Data Collection Form This form is filed by mediators with mediator statement and copy of order on appointment.  
NHJB-2385-F
(12/07/2006)
Mediation Considerations
Distributed to parties at First Appearance, listing statutory reasons why they may not be appropriate for mediation.
 
NHJB-2052-F
(08/20/2014)
Mediation Participation Agreement
Form completed by parties at beginning of divorce or parenting mediation, setting forth the terms of mediation, including payment.
 
NHJB-2782-FS
(02/14/2013)
Mediation Payment Worksheet This form is to be used when parties are ordered to mediation in parenting or divorce cases.  
NHJB-2324-F
(08/20/2014)
Mediation Report
This form is completed following each mediation session conducted by a court-appointed mediator in a marital or parenting case. The form guides the court in scheduling the next event in that case.
 
NHJB-2681-FS
(03/29/2012)
Mediator Statement - Divorce/Parenting
Statement submitted by mediator, itemizing fees and expenses in Divorce/Parenting cases
 
NHJB-2682-F
(01/01/2011)
Mediator Statement - Voluntarily Mediated Adoption/Minor Guardianship
Statement submitted by mediator, itemizing fees and expenses in Voluntarily Mediated Adoption and Minor Guardianship cases
 
NHJB-2091-DFPS
(08/20/2014)
Mediation Questionnaire Circuit Court divisions and Superior Court mediators will give the form to the parties after mediation, so they may complete and return to the clerk’s office in a sealed envelope.  
NHJB-2262-DFS
(12/15/2006)
Statement for Services other than Counsel
Statement itemizing the duration and cost of services other than counsel provided to a party by a person or association, after such services have been approved for payment by the court.
 

 

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