Request for Mediation Guide

The Request for Court Ordered Mediation (FA-4134) is used to ask the Family Court Commissioner to order you and the other party to attend mediation when you disagree on legal custody or physical placement of a child.

Procedural Checklist

1. Complete the Request for Court Ordered Mediation (FA-4134).
2. If a domestic abuse or harassment restraining order or injunction is in effect, attach a copy.
3. Come to the Family Division Office between 8:30 am and 4:00 pm, Monday through Friday, to have your form reviewed for completeness
4. Make three (3) additional copies. You can make your own copies in the Family Division Office for $.25 per page on the coin-operated copier. Please bring cash as it accepts $1, $5, $10 bills and coins only.
5. Mail a copy of the request to the other party.
   • An Affidavit of Mailing (FA-4121) may be completed and filed with the Court for verification of mailing
   • File the original Request for Court Ordered Mediation with the court.
6. Shortly after receiving the form, the court will review it, and if appropriate, will order mediation.
7. If ordered, you will receive an Order for Mediation and you may receive other instructions as necessary. Follow those instructions; however, if a restraining order or injunction is in effect and you fear your actions may violate the order, contact the court for possible alternate instructions.
8. Go to your scheduled mediation.
9. If mediation
   • is successful: the Mediator will draft your agreement to be filed and signed by the court.
   • is not successful: you may call the Court Self-Help Center for other options.