If you would like to be considered for a Fee Adjustment based on your income, please complete the Fee Adjustment Application below, and submit it along with supporting documents and an administrative fee of $50. 

The documentation we request is confirmation of the last 3 month’s household income (wages, government assistance, and other sources) and the number of people in your household. 

The application form, $50 fee, and the complete supporting documentation must be submitted when you agree to participate in mediation. 

We will not consider Fee Adjustment Applications on the day of a scheduled mediation.

Fee Adjustment Application