CW5: financial eligibility form for clients wanting family mediation

Controlled work form for legal aid clients requesting family mediation, with section to be signed by the mediator.


CW5: Help with Family Mediation

This file may not be suitable for users of assistive technology. Request an accessible format.

If you use assistive technology (such as a screen reader) and need a version of this document in a more accessible format, please email Please tell us what format you need. It will help us if you say what assistive technology you use.


Mediator’s section:

  • mediation details
  • signature

Client’s sections:

  • eligibility
  • capital
  • income
  • certification

Solicitor’s sections:

  • certification
Published 1 April 2013
Last updated 25 May 2018 + show all updates
  1. Published new version with updated privacy notice. These changes are part of our preparations for new data protection legislation (GDPR) which comes into force on 25 May 2018.
  2. First published.