Conflict:
It makes sense that we all tend to see things differently.
We have different life experiences, information, judgements, perspectives. interpretations and interests. We all can tend to become fixed and rigid in our expectations and beliefs about what's "right or wrong".
Conflict occurs when there is a perception of competing interests between people. Because of our perceived differences, conflict seems to be a natural and normal occurrence in our lives.
Mediation Process:
The mediation process involves the use of collaborative techniques by a mediator, who is a neutral third party. The mediator informally assists disputing parties in voluntarily reaching their own mutually acceptable settlement of some or all of the issues in dispute by structuring the negotiation, maintaining the channels of communication, articulating the needs of each party, and identifying the issues.
Mediators are committed to a process that is: voluntary; private; confidential; self-determining; creative; practical and flexible. We help you create an informed, mutual decision.
Mediator Skills:
Mediators are not decision-makers or judges. Generally speaking, mediators display the following attributes: patience; acceptance of individual differences; flexibility; creativity/inventiveness; practicality; task-oriented; objectivity; focus; ability to analyse; intelligence; ability to recognize and manage power; strong verbal skills; active listening skills; ability to control the process without dominating the parties; and, confidence in the ability of the process to generate a satisfactory result.
Separating?
Making the decision to complete this chapter of your life can be a difficult process. Using the services of a professional mediator is the best alternative to litigation. We will help you work through and mutually agree on delicate and sensitive issues like parenting, new partners, asset division and financial support with awareness and understanding. We will help help you develop an agreement that you both can support because it will come from you; it is your agreement.
Helpful Links:
http://www.attorneygeneral.jus.gov.on.ca/englis/family/divorce/
http://www.justice.gc.ca/en/ps/sup/grl/ligfed.html
http://www.justice.gc.ca/en/ps/pad/index.html
http://www.justice.gc.ca/en/ps/sup
Prior to attending your first appointment please copy and paste the following form into your word processing program and complete the information. When you complete it you may bring it to your first appoinment.
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COUNSELLING & MEDIATION SERVICES
Leland Clipperton, H.S.C.
Phone: (905) 510-9117
(705) 443-8290
Email: info@CounsellingandMediation.com
Web Site: www.CounsellingandMediation.com
Counselling & Mediation Services
Intake Form
Please take a few moments to answer this questionnaire as completely as possible.
The information will assist us in facilitating the settlement discussions on your behalf.
This document is strictly confidential.
Please mark clearly any information which you are uncomfortable discussing with the other party in mediation .
Today’s date: Referred to mediation by:
1.) GENERAL INFORMATION:
Your FULL NAME:
Date of Birth:
Address: Apt/Unit #
City Postal Code
Telephone: Alternate - Friends phone #
Cell Phone Pager
Your EMPLOYER:
Employer telephone # Okay to call you at work?
Work Email Okay to email @ work?
Your LAWYER: Retained now, Yes No
Lawyers Telephone Lawyers email
FORMER PARTNERS NAME:
Address: Apt / Unit #
City Postal Code:
Home Phone* Cell Phone*
Work Phone * Email*
* If you do not have a reliable method of contact please advise the intake mediator.
Do you have any interest in reconciliation with this person?
Cultural Interpreter: (if applicable) what language(s) would be required
Is your former partner aware of your interest in Mediation?
Have they made an Mediation Intake appointment?
If No or Don’t know: How would you like your former partner to be invited to participate?
a) I will ask, Yes No OR
b) Could the Counselling & Mediation Services contact them?
2.) INFORMATION FOR THE MEDIATOR
1. a) Did you and your former partner live together? YES ( ) NO ( ) if No go to b)*
When did you begin living common-law? month year
and /or What was your date of marriage? month year
b)* How long did you date / go out together months years - if No to 1a
c) When did you last separate / stop going together? month year
2. Are there children from the marriage/relationship with your former partner ?
NO ( ); if YES ( ) Please complete below.
Child’s Full Name | M/F | Date of Birth | Age | Child now living with |
3. When reflecting on your marriage/relationship, what has been the most positive aspects and what has been the most negative ?
Positive aspects?
Negative aspects
4. Are you currently in a new marriage/common-law relationship? YES ( ) NO ( )
If so, since when? Name of current partner:
Do you have other children not mentioned above? YES ( ) NO ( )
Children from this new relationship.
Please provide (with a simple explanation) what you perceive as the issues for Mediation..
Issues Why is this a Concern?
a
b
c
d
6. a) Have any legal proceedings commenced in court? YES ( ) NO ( )
If yes, please provide the following:
a. court file #
b. next court date
c. order or agreement currently in force
b) Have you have signed Separation Agreement with your former partner? YES ( ) NO ( )
i. When was it signed
ii. Are there issues that you would like to review or change in this agreement?
Please describe
7. a. Are you entering into mediation voluntarily? YES ( ) NO ( )
If No, Please explain
b. Why have you chosen mediation to resolve your Family Law matter?
Please explain
8. Are there any other significant adults involved in the care of your children?
(i.e. grandparents, other family members, daycare providers?)
9. What is the highest level of education you have completed? (circle number)
1. less than high school 2. high school diploma
3. some post-secondary schooling 4. college/technical degree
5. university degree, undergraduate 6. other
10. In which of the following groups does your yearly gross income fall? (circle number)
1. less than $15,000 2. $15,000 - $29,999
3. $30,000 - $59,999 4. $60,000 or more
11. What is your yearly gross household income? (Income from all sources in your current home.
For example, new partner’s, workers compensation - all income other than child support.) (circle number)
1. less than$15,000 2. $15,000-$29,999
3. $30,000 - $59,999 4. $60,000 or more
12. Which of the following languages do you understand and speak the best?
1. English 2. French 3. other
13. a) Which of the following best describes where you live at the moment?
1. housing owned with a mortgage 2. housing owned without a mortgage
3. housing rented privately 4. housing rented from Ontario Housing
5 friend/relative’s no rent 6. friend/relative paying rent
7. other
b) Are you currently living in the matrimonial home?
1. yes 2. no
c) At the time of your final separation, who moved out of the family home?
1. me 2. partner 3. both 4. neither
14. How old were you when you and your partner got married or began living together?
Me: years old Partner: years old
15. Who made the decision to separate?
1. me 2. partner 3. both
16. Couples who separate/divorce do so for a number of reasons. Please list the 3 which best suit your reasons for separating:
#1. Reason
#2. Reason
#3. Reason
17. a) Are you and your partner living in separate residences at this time?
1. no (see c) 2. yes (see b)
b) If yes what date did you begin living separately?
month year
c) If no please explain the current arrangements.
18. Who did the child(ren) live with when you separated?
1. me 2. partner 3. both
19. Who are the child(ren) living with now?
1. me 2. partner 3. both 4. other
20. At the present time, with whom are you living? (circle any that apply)
1. new partner 2. parents
3. other relative 4. friends
5. alone 6. other (please specify):
21. When you were together, describe what would typically happen when either you or your
former partner became angry.
22. Describe any instances of verbal, emotional or physical abuse.
23. When you were together with your former partner, how did you manage your finances?
24. Between 1 and 10, what is your level of comfort in participating in mediating with your former
partner in the same room?
Why?
25. How do you feel your former partner will comply with decisions made during the mediation?
26. Describe any misuse or abuse of drugs or alcohol in the relationship?
27. How were decisions made with your former partner?
28. What are you hoping to achieve from mediation?
Thank you for taking the time to complete this form.
Services for family mediation, divorce mediation, mediation services, counseling, marriage counseling, family counseling, relationship counseling, grief counseling, couple counseling, anger management, counseling services, depression, alternative dispute resolution, teen counseling, school counseling.