Kent County, MI · Kent County
Domestic Violence Screening for Referral to Mediation
This court screening form is completed by a plaintiff or defendant referred to mediation to report known domestic violence-related actions involving either party.
At a glance
- Issued by
- City of Kent County · Kent County, Kent County, Michigan
- Notarization
- Not required: file this form without a notary.
- Official source
- kentcountymi.gov
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
What this form is
This court form screens parties for domestic violence concerns before referral to mediation. It asks the plaintiff or defendant to identify known personal protection, domestic violence criminal, and pending child protective actions involving either party, including related case and court details. The form says not to use it for Friend of the Court alternative dispute resolution under MCR 3.224 and directs represented parties to complete it with an attorney.
Who needs it
A plaintiff or defendant involved in a mediation referral should complete it, with their attorney if represented, unless participating in Friend of the Court alternative dispute resolution.
How to submit it
Return the completed form to the ADR clerk at the court address shown on the form within 7 business days.
About notarization
This document is signed and dated without a notary; it does not identify any attachment or related step that must be notarized or sworn.
How to submit this form
- 1
Download the Form
Download the Domestic Violence Screening for Referral to Mediation form.
- 2
Complete the Screening
Provide the requested party and case information and list known actions involving either party. If represented, complete it with your attorney.
- 3
Check the Form
Do not use this form for Friend of the Court alternative dispute resolution under MCR 3.224.
- 4
Return It to the ADR Clerk
Return the completed form to the ADR clerk at the court address shown on the form within 7 business days.
Frequently asked questions
- What does this screening form ask about?
- It asks about known personal protection actions, domestic violence criminal actions, and pending child protective actions involving either party, including case and court details.
- Do I need a notary for the Domestic Violence Screening for Referral to Mediation?
- No. This document is signed and dated without a notary, and it does not identify any attachment or related step that must be notarized or sworn.
- How do I submit the screening form?
- Return the completed form to the ADR clerk at the court address shown on the form within 7 business days.
- Should I use this form for Friend of the Court alternative dispute resolution?
- No. The form says not to use it if you are participating in Friend of the Court alternative dispute resolution under MCR 3.224.