Defendant (Last, first, middle initial) Docket number (if already assigned)Plaintiff (Last, first, middle initial)
Address of courtJudicial District
Instructions
Complete this form if you are participating in, or have participated in, either
private mediation or a collaborative divorce process to try to resolve your case.
STATE OF CONNECTICUT
SUPERIOR COURT
www.jud.ct.gov
NOTICE OF MEDIATION OR
COLLABORATIVE DIVORCE
JD-FM-278 New 11-19
COURT USE ONLY
MEDCOL
*MEDCOL*
For information on ADA accommodations,
contact a court clerk or go to: www.jud.ct.gov/ADA.
Return Date
At (Town)
1. Notice is hereby given to the Court that the parties in this case are participating in or have participated in (Select one):
Mediation (Provide the name, address, phone number, and e-mail address of the mediator)
Collaborative Divorce (Provide the name, address, phone number, and e-mail address of each collaborative attorney)
Date signed
Self-represented plaintiff's or attorney's signature
Print name of self-represented plaintiff or attorney
Date signed
Self-represented defendant's or attorney's signature
Print name of self-represented defendant or attorney
Must be signed by each party.
May be signed by the party's attorney of record if that person is represented by an attorney in the divorce case:
E-mail address
Address (Number, street, apartment number, city, state, and zip code)
Name of Mediator
Telephone number
E-mail address
Address (Number, street, apartment number, city, state, and zip code)
Name of collaborative attorney for plaintiff
Telephone number
E-mail address
Address (Number, street, apartment number, city, state, and zip code)
Name of collaborative attorney for defendant
Telephone number
2. Date(s) Mediation session(s) or Collaborative Divorce session(s) completed or anticipated to be completed:
Date(s) of completion or anticipated completion
