Schedule a Mediation

Fill out the information below and click the SEND button at the bottom of this form. Your information is confidential and will not be shared without your permission.

Here’s what happens next:

  1. A Case Manager will call to discuss our services and see if they are a good fit for your situation.
  2. Sometimes more information is needed, so we may have some questions.
  3. Once we determine the right service for your situation, we will discuss a plan for next steps.

Get Started
* = required field
Your name *
Business name (If Applicable)
Telephone number *
 Cell Home Work
Email address
Mailing address *
City *
State *
Zip *
Please check the box next to the type of dispute that is most like yours.  Neighbors, animals, noise, property line Business and contracts Workplace Divorce and parenting plans Landlord, tenant or homeowners association School Interpersonal, friends or family Foreclosure Other
Are you scheduled to appear in court?  Yes No
So, when is your court date?
At which court house?
Case number:
Financial value of the dispute: $
Please give us a brief description of the dispute.
(Maximum 300 characters)
OPTIONAL: The DRC collects demographic statistics for our funders.
It would be helpful if you would be willing to provide following demographic information.
Your age:
Your race or ethnicity:  African American Asian Caucasian Hispanic Mixed Race Other:
Your gender:  Male Female
Your estimated gross annual Income (before taxes): $
Please fill out the information you know about the other party(s) in your dispute.
We will only contact the other party AFTER a phone conversation with you.
Other party's name(s)
Business Name (If Applicable)
Telephone number
 Cell Home Work
Email address
Mailing address
City
State
Zip
Have you contacted the other party about using the DRC's mediation services?  Yes No