Apply for Free/ Reduced Fees

Income Survey

Income Survey

Fees for mediation are split evenly between the parties, unless you have made a mutual decision together to alter this arrangement. If you believe mediation will be of assistance to you but don’t feel you can afford the process, we offer our services on a sliding scale based on federal poverty guidelines. Please submit the forms below and remit the $25 administrative fee.

1. HOUSEHOLD INFORMATION

Beginning with yourself, list all people living with you for whom you are responsible or with whom you share food and household expenses regardless of age or relationship to you. Include the gross income* of every person over 18 years of age with whom you share household expenses.
First Name, Last Name
Husband, daughter, etc...
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First Name, Last Name
Husband, daughter, etc...
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First Name, Last Name
Husband, daughter, etc...
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First Name, Last Name
Husband, daughter, etc...
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First Name, Last Name
Husband, daughter, etc...
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2. Financial Information

A. Employment

B. Other Income
(Enter amounts for applicable options)

C. Deductions

STATEMENT OF VERIFICATION

I verify, under penalties of perjury, that the information given above is true and correct and that, if any of this information changes after submitting this form, I will inform Mountain Mediation Center.

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Valeria Jimenez – Case Manager & Outreach Coordinator

Valeria is the Outreach & Program Coordinator for Mountain Mediation Center, administering the landlord-tenant eviction diversion program in partnership with local organizations to help prevent and resolve landlord-tenant disputes. She specializes in public outreach, collaborating with agencies and community partners, and connecting communities to resources.

During her time at the Utah State Courts, she managed statewide community outreach initiatives, education of court programs to the public, and was chosen as a recipient of the Excellence in Advancing Justice award. Beyond her professional capacity, Valeria volunteers with We Rise First-Generation Scholars, a program of the Wasatch Education Foundation. Valeria is passionate about bringing young Latino leaders together and building community in the professional, academic, and civic space. She has plans to continue her education by earning a J.D. in the near future.

Kris Campbell – Program Director

Kris is the Program Director for Mountain Mediation Center, overseeing MMC’s programs, fundraiser, and rapidly expanding training program, and coordinating our dedicated volunteers. He is passionate about bringing people together to work through conflicts productively. Kris began his work with MMC as a volunteer in 2020, facilitating Community Conversations and leading training sessions to build understanding, connection, and community along the Wasatch Back. In 2023, Kris served as MMC’s Board Chair. 

When he’s not at work, Kris often spends time with his kids, serving the community through Rotary, Braver Angels, and the Park City LGBTQ+ Taskforce, or exploring area trails.

Gretchen Lee – Executive Director

Gretchen is an attorney and a court-qualified mediator with the Utah Courts. She has an extensive government relations background- having worked as an attorney for the Utah State Legislature as well as the private and nonprofit sectors drafting resolutions, initiatives and other policy documents. Gretchen serves on the Board of Trustees for the Utah Council of Conflict Resolution and is a member of the Restorative Justice Collaborative of Utah. She graduated from Colgate University and Emory School of Law.