Alternative Dispute Resolution Summary

IN THE UNITED STATES DISTRICT COURT FOR THE NORTHERN DISTRICT OF TEXAS __________ DIVISION ALTERNATIVE DISPUTE RESOLUTION SUMMARY Provider must file completed form, in duplicate, with the U.S. District Clerk upon completion of ADR. 1. Civil Action number: _____________________________________________________2. Style of case: ____________________________________________________________3. Nature of suit: ___________________________________________________________4. Method of ADR used: Mediation Mini-Trial Summary Jury Trial5. Date ADR session was held: ________________________________________________6. Outcome of ADR (Select one): Parties did not use my services. Settled, in part, as a result of ADR. Settled as a result of ADR. Parties were unable to reach settlement. Continuing to work with parties to reach settlement (Note: provider must file supplemental ADR Summary Form at conclusion of his/her services). 7. What was your TOTAL fee: $____________________________________ 8. Duration of ADR: _________________________ (i.e., one day, two hours) 9. Please list persons in attendance (including party association, i.e., defendant, plaintiff): (Provider)________________________________ ________________________________ ________________________________ ________________________________ ________________________________ ________________________________ ________________________________ ________________________________ Please provide the names, addresses, and telephone number of counsel on the reverse of this form. 10. Provider information: ______________________________________ ______________________ Signature Date ______________________________________ ______________________ Address Telephone<<<<<<<<<********>>>>>>>>>>>>> 2 Alternative Dispute Resolution Summary Continued Please provide the names, addresses, and telephone numbers of counsel: Name: ______________________________ Name: ______________________________Firm: ______________________________ Firm: ______________________________Address: ____________________________ Address: ____________________________ ____________________________ ____________________________Phone: _____________________________ Phone: _____________________________Name: ______________________________ Name: ______________________________Firm: ______________________________ Firm: ______________________________Address: ____________________________ Address: ____________________________ ____________________________ ____________________________Phone: _____________________________ Phone: _____________________________Name: ______________________________ Name: ______________________________Firm: ______________________________ Firm: ______________________________Address: ____________________________ Address: ____________________________ ____________________________ ____________________________Phone: _____________________________ Phone: _____________________________Name: ______________________________ Name: ______________________________Firm: ______________________________ Firm: ______________________________Address: ____________________________ Address: ____________________________ ____________________________ ____________________________Phone: _____________________________ Phone: _____________________________