Please fill in the information on this form and bring it with you to the Foreclosure Mediation Pre-screening
meeting. The date and location of that meeting is contained in the Summons you received with your complaint.
The information provided will be used by the Court Mediator to make an initial determination if this case is
suitable for mediation. This information will not be shared with anyone, unless you agree and then only with a representative of your mortgage lender.