SMU Plano Mediation & Conflict Resolution Services

Mediation request form

Please Return Form Via Fax to 972-473-3484

Email to dvaden@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 # if applicable: _______________________________________________

________________________________________________________________________________

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: The more information you can provide, the better _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Previous Offers Exchanged: Information as to why the offer was not accepted is helpful as well _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Suggested Dates for Mediation: __________________________________________

Have these dates been approved by the other parties? ______________________

Included Documents, if applicable:  please circle

Mediation Order      General Pleadings      supporting documents      Social Study

Attendance of anyone other than Parties / Attorneys

must be agreed upon by all parties prior to mediation.

For Family Cases Only:

History of Family Violence or Protective Orders?_______    Social Study?  ________ if yes, please include a copy with this request

Name of person submitting request:  _______________________________________