Mediation Intake Information

Illinois Court Mediation Pre-Mediation Information
It is helpful for me to have some background about each parent, the dynamics between the parents, and information pertaining to the child(ren) of the parties. For those reasons, and for purposes of scheduling mediation, I am requesting the following information:
Full Name*

First NameLast Name
Email*
example@example.com
Court Ordered MediationPrivate Parenting PlanPrivate Dispute Resolution
If court ordered, please select County where case/divorce is filed:
If private parenting plan or dispute resolution, please skip this question.
Judge Referring to Mediation
If private parenting plan or dispute resolution, please skip this question.
If other, please specify:
Court Case Number
This can be found on the Order of Referral to Mediation which you received from the circuit clerk.
TELL ME ABOUT YOUR WORK: Are you employed? If so, where do you work? What is your position and what is your work schedule? What days of the week do you work?
Mediations take place at my office located at 2101 Windish Drive, Galesburg, IL, or remotely via Google Meet or Zoom. Currently, I work full-time from 7 AM to 5 PM, Monday through Thursday. I generally have ability to schedule mediations seven days per week in the evening or on weekends. If you need a mediation session during normal business hours in the middle of the week, please write that below and I will make time available.
What availability do you have for scheduling mediation considering the time commitment detailed above? Do you prefer morning, afternoon, or evening? Do you prefer weekday or weekend? Do you prefer meeting in-person or over digital video chat?

What are the main issues as it relates to your child(ren) and the other party?
Has there ever been any domestic violence between the parents or against any child of the parties?
Has there been any substance or alcohol abuse present with either parent?
Tell me about each child you have with the other parent, including child's name, age, grade and school (as applicable), and any health or developmental issues the child may have. Anything else about your child I should know? (Please answer these questions about each child).
Anything else you think I should know in general? Do you have questions for me before mediation?

Parenting plans cover parenting time (regular/weekly schedule, holiday, and vacation), significant decision-making responsibilities, the Right of First Refusal, transportation and location of exchanges, and a lot about communication. I am there to walk you through it and provide information and suggestions to the extent necessary. If you don’t understand what all or some of those things are—no worries! I will be explaining everything during our mediation session, topic-by-topic.
What kind of parenting time schedule are you seeking with the child(ren)? [If you know; its not required that you know but it is suggested that you have some idea.]
If this is a relocation case, please detail why you believe it is in your child's best interest that the relocation occur, where you intend to relocate, and why. If you're on the other side of the relocation, please explain why you believe it's in your child's best interest for the relocation not to occur.
If this is a modification of an existing agreement or parenting time plan, please detail what kind of significant changes that have occurred since your order was entered and why you believe a modification is or is not in the child(ren)'s best interests.
What other issues do you think are important to discuss in mediation?
Illinois Court Mediation charges a flat fee for $800.00 per mediation. This covers all prepartion by the mediator, meeting with clients, the mediation sessions, and all paperwork following the mediation. A private mediation can be paid by one party, through it is best practice to split the fees 50/50. If court mandated mediation, generally the fees are split 50/50 (but this is not true in all cases).

After mediation I put together any agreements reached and send those in writing to each party and any attorneys of record so that the agreements can be entered as an agreed order with the Court. The court does not see the substance of mediation because mediation is confidential. I provide a report letting the court know when mediation took place, how long it took, and whether a full or partial agreement was reached, or no agreement at all. Until such time as the court is presented with an order, the court doesn’t know what those agreements are.
I will need to file for a waiver for Court Fees.I understand I am responsible for 50% of the fees, due at time of mediation, unless other arrangements are made.
Should be Empty:

Illinois Court Mediation Pre-Mediation Information