Divorce
Mediation Homework
If
you are interested in mediation through this office, it will same time and
money if you and your spouse complete the following questionnaire prior to our
first mediation session.
Your
answers to these questions should be written on this sheet and brought
with you to the session. Use more paper if you need more space. Please keep a
copy for
yourself.
1.
Identifying Data:
a. Full Name:
b. Maiden Name (if applicable):
c. Address:
d. Home Telephone Number:
e. Work Address:
f. Work Telephone Number:
g. Preferred Mailing Address (if different
from above):
h. Date of Birth:
i. Social Security Number:
2.
Marriage:
a. Date and Place of Marriage:
b. If separated, date and place you last
lived together:
c. Have there been prior separations? If so,
list dates and duration:
3.
Efforts at Reconciliation:
a. Have there been efforts at reconciliation
of this marriage?
b. If so, please describe: how long ago?; are
these efforts still continuing?;
c. who provided professional help, if anyone?
4.
Legal Representation:
a. Do you have an attorney in this matter?
b. Name:
c. Address:
d. Telephone Number:
5.
Children of this Marriage:
Please provide the names, dates of birth and
school grade for each of your children:
a. Living with whom:
b. Is any third person involved in their
care?
c. Present arrangements for sharing time with
the children, if separated:
d. List any current medical problems of the
children or any anticipated
medical
or dental expenses.
e. Are any of the children receiving
psychological counseling?
Do any of them have special educational
needs?
Are any of them having problems in school?
f. List any trust funds or other property
owned by the children or held for
them.
Do you expect them to receive property in the
future, by gift or inheritance?
6.
Prior Marriages, if any:
a. Date:
b. Place:
c. Prior Spouse’s Name:
d. Where/When/How Ended:
e. Children of Prior Marriage; if any:
(again, please provide the names, dates of birth and school grade for each
child) Also, indicate who each child is living with.
f. Are there any existing financial or
custody obligations?
7.
Employment and Vocational Skills:
a. Employer:
b. Can you be called at work?
c. Work hours:
d. Salary (annual) or hourly wage:
e. Bonus, if any:
f. Other Compensation or Benefits (including
fringe benefits):
g. Brief Job Description or Title:
h. Length of Employment:
i. Retirement Plans (attach all current data
you can obtain): YES NO
j. Post-secondary Education, including
degrees received and years of
attendance:
k. Special Skills:
1. List any other work or jobs you have:
8.
Medical Insurance:
a. Type of medical insurance and name of
insurer:
b. Who pays the premium? What is the cost?
c. Who is covered by this policy?
d. List any medical problems you have:
e. Are you receiving psychological
counseling?
f. How much psychological care is paid by
insurance?
9.
Disability Insurance:
a. Insurer:
b. Amount:
c. Who pays the premium?
10.
Life Insurance on Any Family Member:
a. Company:
b. Face value:
c. Cash Value:
d. Loans against Policy:
e. Beneficiary:
f. Owner:
g. Who pays the premium?
h. Ordinary or whole life, term, annuity or
other type?
i. Insured:
11.
Legacies or Inheritances:
a. Received prior to Marriage:
b. Received during Marriage:
c. Anticipated:
12.
Financial Situation:
Please
fill in a Financial Statement. A form is available on the web at:
http://www.mass.gov/courts/courtsandjudges/courts/probateandfamilycourt/fin_state_0708.pdf
Each
party should print out the form and fill in the form as best as each of
you are able. This will not be a final
version, but serves to give a basic financial picture, much of which is
required as part of the divorce procedure.
13.
Tax Returns:
Please
bring in a copy of your federal and state tax returns for the past three years,
whether
filed jointly or separately.
14.
Proposals:
Describe
any agreements the two of you have reached in terms of your divorce.
List
also any proposals either of you has suggested, or you would like to offer now
for
consideration, in order to resolve remaining issues.
15.
Other Information:
Please
list any other information that you believe may be germane to the
mediation process or the terms of a divorce agreement.