Appellate Screening Form PDF Details

The appellate screening form is a legal document that is used to identify potential issues that may be raised on appeal. The form helps attorneys determine whether an appeal should be filed, and if so, what issues should be included in the appeal. The screening form is typically filled out by the attorney representing the party appealing the decision of the lower court. The appellate screening form can be a helpful tool for attorneys when assessing whether to file an appeal and what specific arguments to raise on appeal. It is important to understand how to complete and use the form in order to make informed decisions about your case. By understanding the purpose of the appellate screening form and completing it accurately, you can improve your chances of having your appeal granted.

Form NameAppellate Screening Form
Form Length3 pages
Fillable fields0
Avg. time to fill out45 sec
Other namesappellate district determine make, ca court of appeal 5th district, fifth appellate district california court of appeal, fifth appellate district

Form Preview Example




This questionnaire will assist the court in selecting cases for mediation to be conducted by a sitting justice of this court. The court intends to select cases shortly after the notice of appeal is filed and before the expense of preparing the record on appeal and appellate briefs has been incurred, This questionnaire is to be completed and signed by each party, or their counsel of record, and served on all other parties, or counsel of record, and filed with the court within ten (10) calendar days of mailing of this questionnaire.

1.Case Name and Number: ____________________________________________________

2.Name of Party/Client:

3.Name of Attorney:

4.Subject Matter (Check all that apply):

Attorney Fees

Family Law

Personal Injury





Professional Negligence

Intellectual Property



Real Estate

Other (specify):

5.Date Notice of Appeal Filed:

6.Trial Court Venue:

7.Name of Trial Judge:

8.The trial court judgment resulted from:

Jury Trial

Court Trial

Summary Judgment




Arbitration Award

Administrative Mandamus

Order (specify):

Other (specify):

9.What was the judgment?:

10.Length of trial or hearing appealed from: _____ (number of court days)


You have a maximum of 1000 words to address questions 11-19 on this page. Please use the text box immediately following question 19 to respond and please identify which question you are addressing (i.e., #2., #3. etcetera.)

11.If there have been any prior appeals in this case (or a related case), state the case name, case number and identify the appellate court:

12.Has anything changed since the most recent settlement offers/demands that may affect the settlement position of any party?: ( If so, explain. )

13.Identify all ADR processes in this case in which you have participated (e.g., mediation, arbitration, or settlement conferences). State the name of all judges, mediators, or other neutral parties involved and the dates of same:

14.Briefly state the facts of the case:

15.Describe any ongoing personal, professional, or business relationship between any of the parties to this appeal:

16.Identify all persons, other than the parties, whose agreement is necessary for the mediation of this appeal and any related litigation or dispute (e.g., an insurance adjuster, spouse, lien holder):

17.State whether any boards, councils or groups of persons must approve any settlement agreement:

18.Identify the primary issues on appeal:

19.Is there a claim for recovery of attorney fees?: (If so, state the amount and legal authority.)


20.Are there any insurance issues that may hinder settlement?:

21.Are there any liens?: (If so, state their amounts.)

22.State whether you believe this case would benefit from a mediation conducted by the appellate court.:

Yes No

23. If you indicated “No,” explain your reasons:

24. The impediments, if any, to resolving this case are:



Print Name of Party or Attorney


How to Edit Appellate Screening Form Online for Free

Any time you desire to fill out screening questionnaire suitability online, you won't need to download any sort of applications - just use our PDF editor. Our development team is continuously working to improve the editor and help it become even better for users with its cutting-edge features. Enjoy an ever-evolving experience now! This is what you will need to do to begin:

Step 1: Simply press the "Get Form Button" at the top of this page to see our pdf editor. Here you'll find all that is necessary to fill out your document.

Step 2: Once you launch the tool, you will see the document all set to be completed. Aside from filling out various blank fields, you can also do other things with the form, including adding any words, changing the original textual content, adding graphics, signing the document, and a lot more.

This form will need specific info to be filled in, so you should take your time to provide what is asked:

1. Complete your screening questionnaire suitability online with a number of major blanks. Note all the important information and make sure there's nothing forgotten!

Writing part 1 in appellate district screening form

2. After the last part is completed, go to enter the applicable information in all these - The trial court judgment resulted, Jury Trial Court Trial , Summary Judgment Arbitration, Demurrer Administrative Mandamus, What was the judgment, and Length of trial or hearing.

The best way to complete appellate district screening form part 2

3. This subsequent part is usually relatively uncomplicated, a proxy DLL deployed on each - every one of these form fields has to be filled in here.

appellate district screening form writing process explained (portion 3)

Concerning a proxy DLL deployed on each and a proxy DLL deployed on each, make sure that you review things in this current part. Those two could be the key ones in this file.

4. This next section requires some additional information. Ensure you complete all the necessary fields - Are there any insurance issues, Are there any liens If so state, State whether you believe this, Yes, and No - to proceed further in your process!

Part # 4 of filling out appellate district screening form

5. Now, the following last subsection is what you should complete before submitting the form. The blanks at issue include the following: If you indicated No explain your, The impediments if any to, Date, Signature, and Print Name of Party or Attorney.

Date,  If you indicated No explain your, and Print Name of Party or Attorney inside appellate district screening form

Step 3: Prior to finishing this file, it's a good idea to ensure that all blanks have been filled in the right way. As soon as you think it's all fine, click “Done." Find your screening questionnaire suitability online the instant you join for a free trial. Quickly get access to the pdf document within your FormsPal cabinet, together with any modifications and adjustments being all kept! Whenever you work with FormsPal, you'll be able to complete documents without worrying about personal data breaches or records getting distributed. Our protected platform helps to ensure that your private details are maintained safely.