CIDRA MEDIATION EVALUATION FORM

Mediator Name:

Case Name and Number:

Case Administrator:

Did the case settle? (Please check one). Yes No

When you have completed the mediation process, please complete this evaluation form and return it to CIDRA so that we may continually improve our program. Thank you.

How was our performance?

Other comments or suggestions:
May we call you for further comments? (Please select one.) Yes No

If you would permit your name to be used as a reference for CIDRA's services, please check here:

Your Name:

Your Telephone Number:

If you would like a copy of this form, please enter your email address here: