Mediation Report Form - Larimer County, Colorado, District Court
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2Larimer County, Colorado, District Court
Larimer County Justice Center
201 LaPorte Avenue, Suite 100
Fort Collins, Colorado 80521-2761
Phone Number (970) 494-3500
In re The Marriage of:
Petitioner:
Respondent:
COURT USE
ONLY
Case No:
Courtroom 2B
MEDIATION REPORT FORM
This Mediation Report Form is to be filed within 21 days of the parties’ first mediation session.
Prompt filing of this form helps the court with case management and allows the court to get the cases
which need a hearing, into court more quickly. Failure to file this report may cause a delay in your case
or result in a dismissal of your motions pending before the court.
Please Check the appropriate box set forth below:
1. _______ The Parties attended mediation on ___________________ and reached a full agreement on
all issues. The parties will file a Stipulation setting forth their agreement within ______ days. (Except in
extreme situations the stipulation should be filed with 14 days of completion of the mediation.)
2. _____ The Parties attended mediation on ________________ but were unable to reach a complete
agreement at the time of the mediation. The parties will file a Partial Stipulation with the court within 14
days of this report setting forth the parties agreement reached at mediation. The following issues still
need to be resolved by the Court:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
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