Mediation Orientation Certificate of Completion

Mediation Orientation Certificate of Completion
Before you begin

Complete this certificate only after you have finished both parts of the orientation on the Court's Mediation Orientation web page:
1. Watch the orientation video.
2. Review the Family Court Services Information Packet.
Declaration

By entering my name and initials below, I declare that I have completed both parts of the Online Mediation Orientation: watching the orientation video and reviewing the Family Court Services Information Packet.
Name

First NameLast Name
I watched California Child Custody Mediation: Focus on the Child’s Needs in its entirety.
Initials – Orientation Video
I reviewed the Family Court Services Information Packet in its entirety.
Initials – Information Packet
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Your Information
Email

Confirmation EmailConfirm Email
Case Number
(optional, if known)
Each parent must submit their own certificate. Submit it online using this form, or download the printable certificate from the Court's website and email it to Mediation@LassenCourt.ca.gov or deliver it to Family Court Services at the Hall of Justice.
Should be Empty: