Fillable ADR ATTENDANCE FORM/CIVIL DIVISION (The Superior Court of California, County of Santa Clara)

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ADR ATTENDANCE FORM/CIVIL DIVISION (The Superior Court of California, County of Santa Clara)

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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
To keep other people from seeing what you entered on your form, please
press the Clear This Form button at the end of the form when finished.
ATTORNEYS
Name:_______________________________ Name:_______________________________
Address: ____________________________ Address: ____________________________
_____________________________________ _____________________________________
_____________________________________ _____________________________________
Phone: ______________________________ Phone: ______________________________
FAX: _______________________________ FAX: _______________________________
Representing ________________________ Representing ________________________
Name:_______________________________ Name:_______________________________
Address: ____________________________ Address: ____________________________
_____________________________________ _____________________________________
_____________________________________ _____________________________________
Phone: ______________________________ Phone: ______________________________
FAX: _______________________________ FAX: _______________________________
Representing ________________________ Representing ________________________
Name:_______________________________ Name:_______________________________
Address: ____________________________ Address: ____________________________
_____________________________________ _____________________________________
_____________________________________ _____________________________________
Phone: ______________________________ Phone: ______________________________
FAX: _______________________________ FAX: _______________________________
Representing ________________________ Representing ________________________
OTHER PARTY REPRESENTATIVES
Name:_______________________________ Name:_______________________________
Address: ____________________________ Address: ____________________________
_____________________________________ _____________________________________
_____________________________________ _____________________________________
Phone: ______________________________ Phone: ______________________________
FAX: _______________________________ FAX: _______________________________
Representing ________________________ Representing ________________________
Name:_______________________________ Name:_______________________________
Address: ____________________________ Address: ____________________________
_____________________________________ _____________________________________
_____________________________________ _____________________________________
Phone: ______________________________ Phone: ______________________________
FAX: _______________________________ FAX: _______________________________
Representing ________________________ Representing ________________________
ADR ATTENDANCE FORM/CIVIL DIVISION
CV-5001 REV 5/06
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ADR ATTENDANCE FORMCIVIL DIVISION (The Superior Court of California, County of Santa Clara)

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Completed 29 June 2021

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