SMU Plano Mediation & Conflict Resolution Services

Mediation request form

Please Return Form Via Fax to 972-473-3425

Email to jelliott@smu.edu

Or regular mail to 5228 Tennyson Parkway, Plano, TX  75024; Bldg. 3 Suite 213

Please note that the Administrative fee of $100 per party will be due 2 weeks prior to the scheduled mediation.   If the mediation cancels during that final 2 week period the fee will not be refunded.

Date of Request: ___________    Type of Case: _______________________________

Style and Cause #: ____________________________________________________________

________________________________________________________________________________

Court Ordered? _______        Specifically Ordered to SMU? ________

Mediation Deadline: ____________________        Trial Date: ______________________

Disputing Parties:

1)     Name:______________________________________________________

Role:  __ Petitioner       __ Plaintiff        __ Respondent       __ Defendant        __ Other

Represented by:  ___________________________________________________

Phone: _________________________      Email:

Fax:  __________________________       Address:______________________________

__________________________________________________________________________

2)     Name:______________________________________________________

Role:  __ Petitioner       __ Plaintiff        __ Respondent       __ Defendant        __ Other

Represented by:  ___________________________________________________

Phone: _________________________      Email:

Fax:  __________________________       Address:______________________________

__________________________________________________________________________

3)  Name: ______________________________________________________

Role:  __ Petitioner       __ Plaintiff        __ Respondent       __ Defendant        __ Other

Represented by:  ___________________________________________________

Phone: _________________________      Email:

Fax:  __________________________       Address:______________________________

__________________________________________________________________________

Add additional parties on separate page

Issues in Dispute: _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Previous Offers Exchanged: _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Suggested Dates for Mediation: __________________________________________

Have these dates been approved by the other parties? ______________________

For Family Cases Only:

History of Family Violence or Protective Orders?_______    Social Study?  ________