Hearing Waiver Form

Background Information

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Date submitted(Required):

This field is required.

Time submitted:

Person waiving an informal administrative hearing

Name or Organization

Select Gender

Select Role

ID Number

Phone number

Email address

Hall/Address

Information to Waive a Case

What is the incident number for the case you wish to waive?(Required) This field is required.

Please check "yes" to note that you wish to waive this case. You should be aware that waiving a case will not allow you an opportunity to speak with a hearings officer when they are making a decision regarding the validity of the report.(Required)

Yes I wish to waive my case No I have decided not to waive my hearing and I will call the hearings officer to schedule an appointment

You must make at least one selection.

Background Information

Person waiving an informal administrative hearing

Information to Waive a Case

Submission