Mediation/ENE: Settlement Checklist

When finalizing an agreement at mediation related to custody and parenting time, it is important to cover everything in detail, that way the deal doesn’t fall apart during drafting of the stipulation. Below is a checklist that can be used to ensure that all areas are covered during mediation.

2025-08-05 Mediation Checklist (Custody & Finances)

MEDIATION SETTLEMENT CHECKLIST – Custody & Parenting Time

Legal Custody		☐ Sole to Mom                      ☐ Sole to Dad                      ☐ Joint
Move from area restrictions?		☐ No           ☐ Yes – Details:
School restrictions?		☐ No           ☐ Yes – Details:
Physical Custody		☐ Sole to Mom                      ☐ Sole to Dad                      ☐ Joint
Parenting Time
School Year☐ 2-2-3: ☐ 2-2-5: ☐ Week on/week off: ☐E/O weekend and one evening per week: ☐ Other: (specify)				Summer☐ Same as school year ☐ 2-2-3: ☐ 2-2-5: ☐ Week on/week off: ☐ E/O weekend and one evening per week: ☐ Other: (specify)
Pick-up / drop off time
Pick-up / drop off location
Right of First Refusal		☐ No                      ☐ Yes. # of hours:
Holiday Schedule		☐ Standard           ☐Other: (specify)
Vacation Parenting Time		☐No	☐ Yes:            ☐ 1 Week           ☐ 2 Weeks        ☐Other:
Other Notes:
Standard of Review for Modification		☐ Standard					☐ Best Interest
Child Related Finances
Anyone on financial assistance?		☐ No          ☐ Yes – Details:
Who will insure children?		☐ Mom                  ☐ Dad                   ☐ Other:
Plan for Child Support		☐ Send to Expedited					☐ Reserve			☐Calculate (see below)
If calculating – need the following
Mom Income:	Dad Income:				Mom’s Overnights:				Dad Overnights:
Health Insurance Costs for Kids:				Dental Insurance Costs for Kids:
Child Care Costs:				Automatic Withholding: ☐ No           ☐ Yes
Deviation to CS?		☐ No                  ☐ Yes – Why:
Child Related Expenses (extracurricular activities, tuition, etc)		☐ Split equally					☐ Split according to PICS
		☐ Responsibility of party incurring					☐Other: (specify)
Dependency Exemptions		Even Years:				Odd Years:		Other:
Other Notes:
Miscellaneous
CD / MH Issues to address?		☐ No        ☐ Yes       Details:
OFW or Communication Language?		☐ No        ☐ Yes       Details:
PTE / PC?		☐ No        ☐ Yes       Details:
Other Agreements:

MEDIATION SETTLEMENT CHECKLIST – Finances

Real Estate

☐ To Husband               ☐ To Wife                         ☐ Sell

Refinance?

☐ No

☐ Yes – how many months?:

SREDJ/QCD

☐ SREDJ

☐QCD

☐Both

Other Notes:

Spousal Support

☐ No

☐ Yes:         ☐Transitional       ☐ Indefinite

Amount: $

Duration:

Karon Waiver?     ☐ Yes                ☐No

Secured by life insurance?  ☐ No         ☐ Yes – How much/duration?

Other Notes:

Checking Accounts

☐ Each keep own       ☐ Split & Close      ☐ See DA Sheet       ☐ Divided below

Bank / Acct #

Awarded to

Other Notes:

Savings Accounts

☐ Each keep own       ☐ Split & Close      ☐ See DA Sheet       ☐ Divided below

Bank / Acct #

Awarded to

Other Notes:

Debts

☐ Each keep their own          ☐ See DA Sheet        ☐Divided below

Lendor / Acct #

Assigned to

Lendor / Acct #

Assigned to

Other Notes:

Retirement & Investment Accounts

☐ Each keep their own            ☐ See DA Sheet         ☐Divided below

Financial Institution / Acct #

Awarded to/Amount:

Financial Institution / Acct #

Awarded to/Amount:

QDROs?   ☐ No         ☐ Yes

If yes – who is drafting?

Gains & Losses? ☐No     ☐ Yes – as of what date:

Other QDRO Specifics:

Other Notes:

Life Insurance

☐ Each keep their own        ☐ See DA Sheet         ☐Divided below

Company / Policy #

Awarded to

Other Notes:

Vehicles

☐ Each keep their own         ☐ See DA Sheet           ☐Divided below

Vehicle

Awarded to

Need Refi?

Need Title Transf?

Other Notes:

Personal Property

☐ Each keep what’s in their possession       ☐ See DA Sheet         ☐Divided below

Specifics of division:

Other Notes:

Equalization Payment

☐ Husband to Wife                        ☐ Wife to Husband                           ☐ None

Amount of Payment: $

☐ Payment via QDRO

☐ Payment via direct payment

If via direct payment:Number of payment(s)Amount of payment(s)Due Date or SchedulePenalty for late payment

Other Notes:

Name Change

☐ No

☐ Yes – To what:

Date of Valuation

Health Insurance for Parties

☐ Each responsible for their own

☐ Other (Specify)

Attorney’s Fees

☐ Each pay their own

☐ Other (Specify)

Updated 8/5/25