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MC 282

Domestic Violence Screening for Referral to Mediation

Michigan · Michigan State Court Administrative Office · Effective September 1, 2023

This form is used to screen for personal protection and domestic violence actions to see if the case should be sent to mediation. It asks the person filling it out to list any related legal actions involving themselves or the other party.

The court describes it as: Court rule / statute: MCR 3.216

Open the official PDFfrom Michigan State Court Administrative Office

Where this fits in a case

General & info

Information / general use — not tied to one step of a case

This form is used when there are actions involving domestic violence or personal protection that might need to be referred to mediation. It must be returned to the ADR clerk within 7 business days.

Either party may file.

Common questions

Who should fill out this form?
The form has sections for the Plaintiff and the Defendant, and it notes that if you have an attorney, the form should be completed with your attorney.
What information does this form ask for?
It asks the person filling it out to list any personal protection actions, domestic violence criminal actions, or pending child protective actions involving the people named.
When must this form be returned?
The completed form must be returned to the ADR clerk at the court address within 7 business days.

Revision history

No changes recorded since we started tracking this form on October 9, 2026. The current version took effect September 1, 2023.

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