Application for FDR Mediation APPLICATION FOR FDR MEDIATION This form can be filled either by the participant or someone else on the participant's behalf, provided that the representative is authorised by the participant.APPLICATION FOR FDR MEDIATION This form can be filled either by the participant or someone else on the participant's behalf, provided that the representative is authorised by the participant.Are you making this application because a judge has directed you to attend FDR Mediation?YesNoIf so, when?[{"field":"ordered_by_judge","logic":"equal","value":"Yes_judge","and_method":"","field_and":"ordered_by_judge","logic_and":"","value_and":""}]Please indicate court reference number:[{"field":"ordered_by_judge","logic":"equal","value":"Yes_judge","and_method":"","field_and":"ordered_by_judge","logic_and":"","value_and":""}]Has a lawyer for the child been appointed by the Court?YesNo[{"field":"ordered_by_judge","logic":"equal","value":"Yes_judge","and_method":"","field_and":"ordered_by_judge","logic_and":"not_equal","value_and":"Yes_judge"}]Please provide contact details of lawyer for the child::[{"field":"Lawyer_for_child","logic":"equal","value":"Yes_lawyerforchild","and_method":"","field_and":"ordered_by_judge","logic_and":"","value_and":""}]How did you hear about the FDR Centre?I've been referred to you by my lawyerI've been referred by a mediatorWebsite search engineRadioCitizens Advice BureauSocial mediaMinistry of Justice websiteOtherPlease indicate the name of mediator or lawyer who referred you to FDR Centre[{"field":"REFERRAL_yn","logic":"equal","value":"Yes_mediator_referral","and_method":"or","field_and":"REFERRAL_yn","logic_and":"equal","value_and":"Yes_by_lawyer"}]Please indicate the way you found the FDR Centre below* Full Funding Eligibility Number of dependants* Maximum annual income** (before tax and any deductions) Maximum fortnightly income (before tax and any deductions) Maximum earnings over past 3 months (before tax and any deductions) 0 (you have no dependants) $23,820.00 $916.15 $5,955.00 1 (a dependent partner or child) $37,722.00 $1,450.85 $9,430.50 2 (a dependent partner and/or children) $54,245.00 $2,086.35 $13,561.25 3 (a dependent partner and/or children) $61,642.00 $2,370.85 $15,410.50 4 (a dependent partner and/or children) $68,882.00 $2,649.31 $17,220.50 5 (a dependent partner and/or children) $77,002.00 $2,961.62 $19,250.50 6 or more (a dependent partner and/or children) $77,002.00 plus $7,124 per extra dependant $2,961.62 plus add $274 for each extra dependant $19,250.50 plus add $1,781 for each extra dependant