0AH 21C SCHOOL DISTRICT REQUEST TO SET (Rev. 07/12) TDD/TYY 800-735-2929 2349 GATEWAY OAKS DRIVE, SUITE 200 SACRAMENTO, CA 95833 Phone 916-263-0550 FAX 916-376-6349 DATE: TO: FROM: OFFICE OF ADMINISTRATIVE HEARINGS 1515 CLAY STREET, SUITE 206 OAKLAND, CA 94612 Phone 510-622-2722 FAX 916-376-6323 320 WEST FOURTH STREET,ROOM 630 LOS ANGELES, CA 90013 Phone 213-576-7200 FAX 916-376-6324 ( PLEASE TYPE AND SUBMIT IN TRIPLICATE ) 1350 FRONT STREET, ROOM 3005 SAN DIEGO, CA 92101 Phone 619-525-4475 FAX 916-376-6325 SCHOOL DISTRICT REQUEST TO SET (Cal. Code Regs., tit. 1, § 1018) CASE TITLE OAH CASE NO. SCHOOL DISTRICT: NAME, ADDRESS, TELEPHONE AND FACSIMILE NOS, SCHOOL DISTRICT ATTORNEY: NAME, ADDRESS, TELEPHONE AND FACSIMILE NOS, RESPONDENT: NAME, ADDRESS, TELEPHONE AND FACSIMILE NOS, RESPONDENT ATTORNEY/REP: NAME, ADDRESS, TELEPHONE AND FACSIMILE NOS, CERTIFICATED EMPLOYEE CLASSIFIED EMPLOYEE PROBATIONARY DISMISSAL STUDENT DISCIPLINE OTHER (LIST) STATUTORY TIME LIMIT EXECUTED TIME WAIVER TIME ESTIMATE FOR HEARING DAYS NO YES IF YES, PROVIDE LEGAL AUTHORITY IF YES, DATE BY WHICH CASE MUST BE HEARD PLACE OF HEARING DISTRICT TO PROVIDE COURT REPORTER HEARING TAPE RECORDED BY CONSENT (Gov. Code, § 11512, subd.(d)) DATES AVAILABLE DATES UNAVAILABLE FOR THE NEXT SIX MONTHS DATES PREFERRED DATES COORDINATED WITH ALL PARTIES? YES NO ADDITIONAL COMMENTS AND/OR INSTRUCTIONS, REQUEST FOR ACCOMMODATION SECURITY REQUESTED (ATTACH WRITTEN REQUEST) REQUEST TO SET ACKNOWLEDGEMENT DATE(S) SET/ STARTING TIME PLACE OF HEARING DATE: BY: American LegalNet, Inc. www.FormsWorkFlow.com