Before you begin

Organize a draft request for California Department of Rehabilitation (DOR) administrative review using the agency's current instructions.

Have these ready

  • Read the decision or notice you wish to challenge.
  • Verify the current review route, recipient, deadline, and relationship to other available procedures before using this draft.

Preparation only. Creating, downloading, or printing this worksheet does not file, serve, or send anything, prove agency receipt, or extend a deadline. Keep a separate record of any actual submission.

  • This is for California administrative-review preparation only; do not reuse it as a Nevada procedure.
  • Drafting, printing, discussing, or generating this document does not submit a review request, prove receipt, or extend a hearing or other deadline.
  • A requested remedy is a proposal, not an agency obligation established by this tool.

How to use it

  1. Identify the decision, action, or omission and the date you learned of it.

  2. Write a short factual chronology with record references.

  3. Explain the concern. If you rely on a legal rule, identify the law, regulation, or decision that supports it.

  4. Request a concrete resolution and separately check how to preserve any other procedural rights.

Prepare a California administrative-review request
Decision or action disputed
Specific resolution requested
Relevant dates

Fictional example

A participant received an unclear decision about an approved course expense. The draft identifies the notice, lists the approval and invoice, and requests a written explanation and review of the disputed charge.

Your worksheet

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Print this worksheet as a blank planning sheet and add notes on your own copy. Editing, review, and text export on this page require JavaScript. Fields remain disabled when JavaScript is unavailable.

Worksheet fields

State what happened and identify the notice or communication.

Describe the action you want reviewed or taken.

Distinguish decision date, receipt date, and dates requiring verification.

Use one event per line and cite the supporting record.

List documents and explain what each supports; do not treat an argument as a finding.

Record the official recipient, current deadline source, and any separate action needed.

Your next action

Check the finished request against current official instructions, seek appropriate help if needed, and preserve evidence of any actual submission.

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