OAH 22 TEACHER LAY-OFF REQUEST TO SET(Rev. 7/12) TDD/TYY 800-735-2929 2349 GATEWAYOAKS DR.,SUITE200 SACRAMENTO,CA95833 Phone 916-263-0550 FAX 916-376-6349 DATE: TO: OFFICE OF ADMINISTRATIVE HEARINGS 1515 CLAY STREET, SUITE 206 OAKLAND,CA94612 Phone 510-622-2722 FAX 916-376-6323 320 WEST FOURTH STREET, ROOM 630 LOSANGELES,CA90013 Phone 213-576-7200 FAX 916-376-6324 FROM: 1350 FRONT STREET, SUITE 3005 SAN DIEGO,CA92101 Phone 619-525-4475 FAX 916-376-6325 TEACHER LAYOFF REQUEST TO SET DISTRICT BOARD NAME, ADDRESS, TELEPHONE, EMAIL and FAX NUMBERS: NO. OF RESPONDENTS NOTICED FOR LAY-OFF: TIME ESTIMATE FOR HEARING HOURS/DAYS: DISTRICT CONTACT NAME, ADDRESS, TELEPHONE, EMAIL AND FAX NUMBERS FOR BILLING: START TIME: HEARING LOCATION: DISTRICT'S REPRESENTATIVE Name, Address, Telephone, E-mail & Fax Nos. RESPONDENTS' REPRESENTATIVE Name, Address, Telephone, E-mail & Fax Nos. Preferred Method of Service: Email Fax U.S. Mail Preferred Method of Service: Email Fax U.S. Mail DATES UNACCEPTABLE: PREFERRED DATES FOR HEARING:*** A PREHEARING CONFERENCE IS REQUESTEDFOR THE FOLLOWING REASONS: STANDARDIZED TESTING DATE: SPRING BREAK: HAVE RESPONDENTS' REPRESENTATIVES RECEIVED A COPY OF THIS REQUEST TO SET? YES NO HAVE RESPONDENTS' REPRESENTATIVES AGREED TO PREFERRED DATES? YES NO THE DISTRICT SHALL PROVIDE A COURT REPORTER FOR EACH DAY OF HEARING 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. ***If you are aware of other districts in the same general location that are likely to be requesting hearings, please note the names of those districts on a separate sheet and submit to OAH. American LegalNet, Inc. www.FormsWorkFlow.com