Mediation Order Form
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1IN THE CIRCUIT COURT OF THE SECOND JUDICIAL CIRCUIT
_________________ COUNTY, ILLINOIS
)
)
_______________________________________
)
Petitioner,
)
v.
)
No.:______________
)
_______________________________________
)
Respondent. )
MEDIATION ORDER
The prerequisites to mediation having been fulfilled and it appearing that mediation of
certain undetermined issues herein is required pursuant to Circuit Rule 21, the court finds:
______ As settlement of the qualifying issues appears imminent, appointment of a mediator is
hereby deferred until the next case management conference.
OR
IT IS HEREBY ORDERED that this cause is referred for mediation of the following
issues:
____ Child Custody; _____ Child Visitation; ____Removal of Child from Jurisdiction;
____ Other _____________________________________________________________.
The court hereby appoints ______________________________________, an approved mediator
of this circuit; or, pursuant to the direction of the Office of Chief Judge, the court hereby appoints
Judge __________________________________________, a judicial mediator, to conduct the
mediation in this case. The Circuit Clerk shall mail or fax to the appointed mediator copies of the
following: this order, record sheets, judgments and orders, pleadings in dispute, financial affidavits,
and pre-mediation questionnaires.
The payment for the private mediation shall be as follows: ____________% by the
Petitioner and ____________% by the Respondent.
A continued case management conference is set for _____________________________at
____________ a.m./p.m. by which setting the mediator, unless appointment has been deferred, shall
report the status of the mediation.
The Circuit Clerk shall mail notice of such setting, together with a copy of this order, to counsel
and unrepresented parties who are not present.
Enter: _______________
____________________________________________
JUDGE
Page 1 of 1
Mediation Order No. 69
Rev. 5/23/2011
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