Pre-filing Mediation Submission Form

All fields marked with an asterisk (*) are required and must be filled in or this form will not be processed.

Select the appropriate division to resolve your dispute* Citizen Dispute SettlementFamily Pre-Filing Mediation

In What County would you like to resolve your dispute?* ManateeSarasota North CountySarasota South CountyDesoto

Your Contact Information (Complainant)

First Name*

Last Name*

Phone Number*

E-mail Address*

Address*

Opposing Party Contact Information (Respondent)

First Name*

Last Name*

Phone Number*

E-mail Address

Address* (Please enter "Unknown" if you do not know the address)

Description of Issues*

Please check if children are involved (only for Family Pre-Filing Cases)

How did you hear about the program?* CDSP Number

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