PALO ALTO MEDIATION PROGRAM
1490 El Camino Real, Santa Clara, CA 95050, (650) 856-4062, pamediation@housing.org
Outreach Evaluation Form
Thank you for utilizing the Palo Alto Mediation Program. This program exists to serve the needs of our community. Your input is essential to our ability to evaluate the performance of the program. Please take a few minutes to complete this survey. Any identifying information in your response will be maintained by this agency in the strictest confidence.
Case Number (optional)
Date of Mediation (optional)
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Month
-
Day
Year
Date
1. How would you rate the overall quality of your contacts with the office staff?
Excellent
Good
Fair
Poor
2. How would you rate the overall quality of your contacts with the mediators?
Excellent
Good
Fair
Poor
3. Overall, were you satisfied with the mediation process?
1
2
3
4
5
Not at all
Definitely
1 is Not at all, 5 is Definitely
Comments:
4. Did you and the other party reach an agreement as a result of the mediation?
Yes
No
Partially
Still pending
5. If yes, were you satisfied with the agreement that resulted from the mediation?
1
2
3
4
5
Not at all
Definitely
1 is Not at all, 5 is Definitely
Comments:
6. Would you recommend the mediation program to others in the future?
Yes
No
Maybe
7. If mediation had not been an option, what action would you have taken to resolve this situation?
Court (Small Claims, other)
Law Enforcement
Government/Public Agency
Attorney
Code Enforcement
Other
8. What was your status in this matter?
Tenant
Landlord
Neighbor
Other
Final comments:
Name (optional):
Submit
Should be Empty: