CASE NAME:

This agency licensing proceeding will be scheduled for hearing before an Administrative Law Judge of the Office of Administrative Courts ("the OAC"). The Division encourages parties to use alternative methods of dispute resolution and offers to the agency and the applicant the opportunity to engage in mediation.

Mediation is a process in which a neutral third party meets with the parties to assist the parties in reaching a negotiated settlement of the disciplinary proceeding. If the parties are able to reach an agreement in this way, they will control the outcome of this licensing case by agreeing to a solution, rather than having a solution imposed upon them by an Administrative Law Judge after a hearing.

In mediation, the mediator facilitates communication between the parties in a private, confidential and informal meeting. If the applicant has an attorney, the attorney will participate. The mediator has no decision-making authority; no settlement or solution will be achieved unless both parties are in agreement. A mediator can often help the parties generate creative options to resolve the case, even though those options would not be available if the case proceeded to a hearing before an Administrative Law Judge. Mediators may be able to assist the parties in reaching a settlement even where the parties' prior, unassisted negotiations have failed to result in an agreement.

If both parties agree to mediate this license application case they may notify the Office of Administrative Courts, which will assign an Administrative Law Judge to conduct the mediation. All of the Administrative Law Judges in the Division are trained as mediators and are available to the parties for this purpose. An Administrative Law Judge who serves as a mediator acts in a completely confidential manner and has no contact with the judge to whom the case is assigned for hearing.

The parties should indicate whether they wish to engage in mediation by completing the information on the reverse side of this form. The license applicant should return the completed form to the Office of Administrative Courts.

AGENCY'S ELECTION TO MEDIATE
(CHECK THE APPROPRIATE BOX)

[_]The agency in the license application proceeding described on the front of this form believes that mediation of this dispute is appropriate and elects to engage in mediation before an Administrative Law Judge of the Office of Administrative Courts.

[_]The agency in the license application proceeding described on the front of this form chooses not to engage in mediation at this time.

__________________________________        ___________________________
(Signature of Agency Official or                               (Date)
Assistant Attorney General)

APPLICANT'S ELECTION TO MEDIATE
(CHECK THE APPROPRIATE BOX)

[_]The applicant in the license application proceeding described on the front of this form believes that mediation of this dispute is appropriate and elects to engage in mediation before an Administrative Law Judge of the Office of Administrative Courts.

[_]The applicant in the license application proceeding described on the front of this form chooses not to engage in mediation at this time.

__________________________________      _________________________
(Signature of Applicant or                                      (Date)
Applicant's Attorney)