To fill out mediation forms correctly, work through them in the order the process requires: a Request for Mediation to start the case, an Agreement to Mediate and a Confidentiality Agreement before the session, a written mediation statement with supporting exhibits, a financial affidavit if money or property is in dispute, and a signed settlement agreement if you reach terms. Use your full legal name on every form, include the court case number if a lawsuit has already been filed, pull every financial figure directly from a source document rather than estimating, and submit everything one to two weeks before the session. Each form has a specific job, and the details you enter carry through to any agreement you sign.
The Request for Mediation
The Request for Mediation (sometimes called a Petition for Mediation) is the first form. It identifies the parties, describes the dispute in a few sentences, and tells the court program or private provider that someone wants to resolve the matter outside of trial. Enter the full legal names and contact information for everyone involved, and give a short, neutral description of the underlying issue — a contract disagreement, a custody matter, a workplace grievance, whatever it is.
If a lawsuit has already been filed, the form will ask for the existing case number. Include it. Court systems use that number to connect the mediation to the court file, and leaving it off creates administrative delay. In court-connected programs, a judge may issue a separate referral order after receiving the request. In private mediation, the request goes to the mediator or service, who then contacts the other side to confirm participation and schedule.
The Agreement to Mediate
Once both sides agree to participate, everyone signs an Agreement to Mediate. This is a contract that sets the ground rules before you sit down. A standard agreement covers:
- Mediator neutrality — the mediator does not represent either side, take sides, or give legal advice.
- Confidentiality — what is said in the session stays in the session, with specific exceptions.
- Voluntary participation — either party can walk away at any point, even in a court-ordered mediation.
- Fees — the mediator’s hourly rate, typically between $100 and $500 per hour depending on experience and complexity, and how costs are split.
- Good faith — both sides commit to honest disclosure and genuine effort toward resolution.
The EEOC’s standard Agreement to Mediate, used in federal employment disputes, describes mediators as “neutral third-party facilitators” who “will not make decisions about ‘right’ or ‘wrong,'” treats all communications as “absolutely confidential,” and bars parties from calling the mediator as a witness in any related proceeding.1U.S. Equal Employment Opportunity Commission. Agreement to Mediate Private mediators use similar language.
Read the fee section carefully before you sign. It locks you into a payment obligation, and most mediators require a retainer or deposit up front.
The Confidentiality Agreement
Confidentiality is a separate form that every participant signs. The core promise is that statements made during the session cannot be used as evidence in a later court proceeding, and the mediator cannot be called as a witness or forced to produce notes. The Southern District of New York’s standard form states that “any communications made exclusively during or for the mediation process shall be confidential,” and “the mediator shall not be inquired of or called as a witness or deponent in any proceeding related to the dispute.”2United States District Court Southern District of New York. Mediation Confidentiality Agreement That same form makes an important distinction: documents that would be discoverable anyway under normal court rules don’t become protected just because someone mentioned them during mediation.
Exceptions You Should Know Before Signing
Confidentiality is broad, but not absolute. The Uniform Mediation Act, adopted in some form by a majority of states, carves out specific situations where mediation communications lose their privilege. The common exceptions:
- Threats of violence — a statement expressing a plan to inflict bodily injury or commit a violent crime.
- Criminal activity — communications used to plan, attempt, or conceal an ongoing crime.
- Child abuse or neglect — statements revealing abuse, neglect, or exploitation of a child or vulnerable adult, particularly in proceedings involving a protective services agency.
- Mediator misconduct — evidence needed to prove or disprove a malpractice claim against the mediator.
- Signed agreements — a written settlement agreement signed by all parties is not confidential.
Some court programs add exceptions beyond this standard list, and some forms ask you to acknowledge mandatory reporting obligations. A mediator who learns of child abuse during a session may be legally required to report it regardless of what the confidentiality form says. Read the specific form in front of you.
Writing the Mediation Statement
The mediation statement (also called a mediation brief or position statement) tells the mediator your side before the session. It is less about legal argument than about helping the mediator understand what happened and where a fair resolution lands.
A workable statement covers four things:
- Background facts — a clear narrative of what happened, told from your perspective but sticking to facts the other side would struggle to dispute.
- Key issues — the specific points of disagreement that need resolving, not every grievance you have ever had with the other party.
- Prior negotiations — any settlement discussions that have already taken place, including what was offered and rejected.
- Desired outcome — what you are looking for, whether a dollar figure, a change in behavior, or a specific arrangement. A realistic range rather than a single number gives the mediator room to work.
Most mediators prefer briefs of ten to fifteen pages, depending on complexity. The California Rules of Court give mediators discretion to request a “short mediation statement” covering the issues in dispute and possible resolutions.3California Courts. California Rules of Court 2026 – Rule 3.894 Attendance, Participant Lists, and Mediation Statements Overloading the brief with case law rarely helps. If your case turns on a specific contract clause or statute, quote the key language and move on.
Ask the mediator whether statements are exchanged between the parties or kept confidential before you write anything you would not want the other side reading. Practice varies.
Financial Affidavits and Supporting Exhibits
Financial Affidavit
When money is in dispute — child support, alimony, property division, business damages — you will almost certainly complete a financial affidavit. This is a sworn statement listing income, expenses, assets, and debts in detail. Court-connected family mediation programs routinely require affidavits from both parties before a session can be scheduled.
The form asks for specifics: monthly gross and net income, sources of income (salary, investments, rental properties), recurring expenses (mortgage, utilities, insurance, childcare), and a full inventory of assets including real estate, bank accounts, vehicles, and retirement funds. Pull numbers directly from bank statements, tax returns, and pay stubs. These are sworn documents, signed under oath and often before a notary. Knowingly submitting false figures can bring fines, sanctions, or imprisonment for perjury, and a court that later discovers hidden assets can overturn the resulting settlement entirely.
List of Exhibits
Your statement makes claims; your exhibits prove them. Index the documents you intend to rely on — signed contracts, invoices, medical bills, repair estimates, emails, text messages, photographs — label them clearly (Exhibit A, Exhibit B, and so on), and provide copies for both the mediator and the other party. Bring originals to the session itself, since the mediator may ask to see the actual document if a figure or date is challenged.
Forms Tied to Specific Disputes
Corporate Authorization
When a business is a party, the person who shows up needs authority to settle. Many courts and mediators require a written authorization confirming that the attending representative can make binding decisions on the company’s behalf. The representative must hold a position that allows them to “speak definitively and to commit the corporation to a particular position.” A representative who has to call headquarters for approval on every number stalls the session, and relying on a phone call to someone off-site is generally considered insufficient.
Proposed Parenting Plan
In custody and family disputes, both parents may be asked to prepare a proposed parenting plan before the session. The plan should address physical custody (where the children live day to day), legal custody (who makes major decisions about education, healthcare, and religion), a visitation schedule, holiday arrangements, and how future disagreements about the children will be handled. Some court-connected programs also require parents to complete an orientation before mediation begins. A concrete, child-focused proposal gives the mediator something to work with.
Filling the Forms Out Without Mistakes
Small errors on mediation paperwork create large problems. Any settlement will incorporate the information from these forms, and mistakes can delay the process or undermine enforceability later.
Use your full legal name — the name on your government-issued ID and on any filed court documents — on every form. Nicknames, shortened names, or maiden names that do not match existing records create identification problems. If a lawsuit has already been filed, write the case number on every document; court systems use it to link the mediation to the case file.2United States District Court Southern District of New York. Mediation Confidentiality Agreement
For the financial affidavit, cross-reference every number against its source document — bank statement, mortgage statement, tax return, pay stub. An incorrect mortgage balance or a misreported income figure does not just stall the session; it creates distrust that poisons the negotiation. If you are not sure about a figure, bring the source document and note the uncertainty rather than guessing.
Most forms are available as fillable PDFs from the court’s website or the mediator’s office. If you are working with paper forms, type your responses or print clearly in black ink. Keep copies of everything you submit.
Where and When to Submit
Submission depends on whether you are in a court-connected program or private mediation.
Court-connected programs often use electronic filing systems that require you to create an account and upload documents in PDF format. The federal courts use the CM/ECF (Case Management/Electronic Case Files) system, which generates an automatic timestamp confirming when your documents were received.4United States District Court for the District of Massachusetts. Electronic Filing (CM/ECF) State courts increasingly run their own e-filing portals. Where no electronic option exists, submit paper copies through the court clerk’s office.
In private mediation, forms generally go directly to the mediator’s office, usually by email or through a secure client portal. Provide copies to the opposing party at the same time unless the mediator specifically asks you not to; some mediators prefer to receive statements confidentially.
Deadlines vary. Plan to have everything submitted at least one to two weeks before the session so the mediator has time to review both sides’ materials. Missing the deadline can result in postponement or, in court-ordered cases, sanctions.
Fees and Waivers
Administrative filing fees are common in both court-connected and private programs. Amounts depend on case type and amount in dispute. FINRA’s mediation program, for example, charges on a sliding scale: $50 for claims under $25,000, $150 for claims between $25,000 and $100,000, and $300 for claims exceeding $100,000, with higher fees for member firms.5FINRA. FINRA Rule 14110 – Mediation Fees Court-connected programs generally charge between $50 and a few hundred dollars per party, though fees vary widely.
On top of the filing fee, you will pay the mediator’s hourly rate or a flat session fee, split between the parties as outlined in the Agreement to Mediate. If you cannot afford the fees, court-connected programs often allow waivers for individuals who meet income thresholds or receive public benefits. The waiver application is a separate form. You will need to demonstrate financial hardship, and the waiver generally covers court-related fees only, not a private mediator’s charges.
The Settlement Agreement
If mediation succeeds, the final form is the settlement agreement. Everything you negotiated gets reduced to writing, and once all parties sign, it functions as a binding contract. A mediator can record the terms the parties agreed to, but drafting new provisions or advising on legal implications would cross into practicing law, which mediators are trained to avoid.
An enforceable settlement agreement needs:
- Specific terms — every obligation spelled out: who pays how much, by what date, in exchange for what. Vague language like “a reasonable amount” or “as soon as practical” invites future disputes.
- Signatures from every party. An unsigned or partially signed agreement is difficult to enforce.
- Voluntary consent, with no coercion or duress.
- Compliance with law. Terms that violate statutory requirements, such as waiving child support (which courts in many jurisdictions will not allow), may be struck down even if both parties agreed.
In court-connected cases, the settlement agreement can be submitted to the judge for approval and incorporation into a court order. Once that happens, violating the terms is not just a breach of contract; it is contempt of court. In private mediation without a pending lawsuit, the agreement is enforceable as a regular contract. Either way, have an independent attorney review the agreement before you sign. Mediators routinely recommend this, and it is the single best way to avoid committing to terms you do not fully understand.