SUPERIOR COURT OF CALIFORNIA
COUNTY OF SANTA CLARA
DEPENDENCY MEDIATION OUTCOME FORM
1. Case Name (Oldest Child):
2. Case Number:
3. Mediation Date:
4. Outcome (Please mark only one of the following):
a. Full Agreement: All issues addressed in mediation were resolved.
b. Partial Agreement: One or more issues addressed in mediation were resolved, and
at least one issue remains unresolved.
c. No Agreement: No issues addressed in mediation were resolved.
5. This form is to be completed by County Counsel on every case following the parties’ return to
Terraine: Please return to the Dependency Mediation Outcome box outside of Juvenile Dependency
South County: Please return to the black drop box on the right side of the lobby as you exit the
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