Online Mediator Activity Form
Include dates in notes if there is a collection of notes included over multiple dates
Mediator Email
Activity Date
Hours
Hours spent on the case
Minutes
Minutes spent on the case
Party Contact Information
Please fill this out only if this is new or different information
Email
Email of the involved party
Name
Name of the involved party
Phone
Phone number of the involved party
Address
Address of the involved party
Party Demographic Information
Please fill this out only if this is new or different information
Gender
Gender of the involved party
Primary Language
Language of the involved party
Age
Racial / Ethnic Origin
Activity Info
Activity Type
Case Number
Case Notes
Notes To Staff
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