Form Cv-5001 -Adr Attendance Form
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SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA CLARA
ADR ATTENDANCE FORM/CIVIL DIVISION
PLEASE MAIL WITHIN 10 DAYS OF THE COMPLETION OF THE ADR PROCESS TO:
ELIZABETH STRICKLAND, ADR ADMINISTRATOR
SANTA CLARA COUNTY SUPERIOR COURT
191 N. FIRST STREET, SAN JOSÉ, CA, 95113
OR FAX TO 408-882-2595
Case Name: ___________________________________Case No: ______________________
Your Name: ______________________________Your Phone Number:__________________
ADR Process:
Mediation
Neutral Evaluation
Other (specify):__________________
Instructions: This form will be used for evaluation of the ADR program. List the names,
addresses, phone numbers, and fax numbers, as available, for all parties, attorneys and other
party representatives who participate in any ADR session in this case, either in person or by
phone. Attach additional pages, if necessary.
Dates of ADR Sessions:
PARTIES
(Counsel should place an X by the names of parties who may not be contacted for an
evaluation of the ADR program without counsel permission.)
Name:_______________________________
Name:_______________________________
Address: ____________________________
Address: ____________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
Phone: ______________________________
Phone: ______________________________
FAX: _______________________________
FAX: _______________________________
Name:_______________________________
Name:_______________________________
Address: ____________________________
Address: ____________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
Phone: ______________________________
Phone: ______________________________
FAX: _______________________________
FAX: _______________________________
Name:_______________________________
Name:_______________________________
Address: ____________________________
Address: ____________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
Phone: ______________________________
Phone: ______________________________
FAX: _______________________________
FAX: _______________________________
ADR ATTENDANCE FORM/CIVIL DIVISION
CV-5001 REV 5/06
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