OFFICE OF ADMINISTRATIVE HEARINGS STATE OF CALIFORNIA GENERAL JURISDICTION DIVISION For more information visit www.dgs.ca.gov/oah/ home.aspx School District Request to Set: Teacher Dismissal Case (Cal. Code Regs., tit. 1, § 1018) DATE: CASE TITLE (TEACHER NAME) NAME OF DISTRICT DISTRICT ATTORNEY/REPRESENTATIVE Name, Address, Telephone, E-mail & Fax Nos. RESPONDENT/APPELLANT/PETITIONER Name, Address, Telephone, E-mail & Fax Nos. RESPONDENT/ATTORNEY/REPRESENTATIVE Name, Address, Telephone, E-mail & Fax Nos. FROM: OAH CASE NO. Preferred Method of Service: Email Fax U.S. Mail Preferred Method of Service: Email Fax U.S. Mail Preferred Method of Service: Email Fax U.S. Mail DISMISSAL FROM EMPLOYMENT (Ed. Code, § 44934) THREE MEMBER COMMISSION REQUIRED DISMISSAL (Ed. Code, § 44944.1) ALJ HEARING ONLY (Ed. Code, § 44934.1)--Solely Egregious Misconduct ALJ HEARING ONLY ­ parties elected to waive hearing by CPC (Waiver attached) (Ed. Code, § 44944(c)(1)) IF DEMAND FOR HEARING IS NOT ATTACHED TO THIS REQUEST TO SET, A HEARING MAY NOT BE SET Has there been an Immediate Suspension Pending Dismissal? YES NO If the parties have agreed to extend the time for hearing under 44944.1(d)(1)(A), please attach a Time Waiver. TIME ESTIMATE FOR HEARING HOURS DAYS Provide at least three DATES PREFERRED (ALL PARTIES) (CCR, tit. 1 § 1018(a)(6) HEARING LOCATION DATE BY WHICH CASE MUST BE HEARD (MONTH/DAY/YEAR) DATES COORDINATED WITH ALL PARTIES? YES NO DATES UNAVAILABLE FOR AT LEAST 6 MONTHS (ALL PARTIES) If no, attach Form 21.1 (Statement of Agency's Reasonable Efforts to Confer). Failure to coordinate dates or provide an explanation may result in OAH unilaterally setting a hearing date. (Ed. Code, § 44944(b)(1)(A).) ADDITIONAL COMMENTS AND/OR INSTRUCTIONS: REQUEST FOR ACCOMMODATION, SECURITY, ETC., SCHOOL DISTRICT WILL PROVIDE COURT REPORTERS FOR ALL HEARINGS. NOTICE: This is not a reservation of dates. Completion of this form does not guarantee that you will receive the hearing dates requested. Dates are subject to availability at the time a Request to Set or other calendar request is processed by OAH. 2349 GATEWAY OAKS DR., SUITE 200 SACRAMENTO, CA 95833 Phone 916-263-0550 FAX 916-376-6349 sacfilings@dgs.ca.gov 1515 CLAY STREET, SUITE 206 OAKLAND, CA 94612 Phone 510-622-2722 FAX 916-376-6323 oakfilings@dgs.ca.gov 320 WEST FOURTH STREET, SUITE 630 LOS ANGELES, CA 90013 Phone 213-576-7200 FAX 916-376-6324 lateacherdismissal@dgs.ca.gov 1350 FRONT STREET, ROOM 3005 SAN DIEGO, CA 92101 Phone 619-525-4475 FAX 916-376-6325 sanfilings@dgs.ca.gov DGS-OAH 21F American LegalNet, Inc. www.FormsWorkFlow.com