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CASE INITIATION

This form is for the information purposes and does not substitute for a charging document. The charging document must be uploaded. Additionally, this form does not replace the need of the initiating party to serve the charging document on all parties to the case.

Case Type:

Professional LicensureTeacher TenureColorado Fair Campaign Practices ActOther

License Type

LicenseApplication

License #

Board

School District

Other Type

Issue 1:

Issue 2:

Issue 3:

Check here if this is a Summary Suspension

Check here if you have already contacted the OAC for a setting date

Setting Date

Setting Hour Time

Setting Minute Time

Setting AM/PM Time

Attach Additional Documents

Use this section to upload copies of notices, Power of Attorney documents or any other documents you want to include with your request.

Additional Document 1

Additional Document 2

Party 1 Contact Information (i.e. Complainant, Appellant, Licensee, etc.)

First Name

Middle Initial

Last Name

Suffix

Company

Address

City

State

ZIP

#####

Phone Number

###-###-####

Email Address

Party 1 is the:

Does Party 1 have a Representative?

YesNo

Party 1 Representative

Is the representative a licensed attorney?

YesNo

Attorney Reg #:

First Name

Middle Initial

Last Name

Suffix

Company

Address

City

State

ZIP

#####

Phone Number

###-###-####

Email Address

Party 2 Contact Information (i.e. Respondent, School Board, Licensing Board, etc.)

First Name

Middle Initial

Last Name

Suffix

Company

Address

City

State

ZIP

#####

Phone Number

###-###-####

Email Address

Party 2 is the:

Does Party 2 have a Representative?

YesNo

Party 2 Representative

Is the representative a licensed attorney?

YesNo

Attorney Reg #:

First Name

Middle Initial

Last Name

Suffix

Company

Address

City

State

ZIP

#####

Phone Number

###-###-####

Email Address

Is there an additional party to this case?

YesNo

Additional Party Contact Information

Role in Case:

First Name

Middle Initial

Last Name

Suffix

Company

Address

City

State

ZIP

#####

Phone Number

###-###-####

Email Address

Additional Party Representative

Is the representative a licensed attorney?

YesNo

Attorney Reg #:

First Name

Middle Initial

Last Name

Suffix

Company

Address

City

State

ZIP

#####

Phone Number

###-###-####

Email Address

Certificate of Service

By checking this box, I affirm that I have served a copy of this Case Initiation form and all attachments to all parties to this matter.

Signature First Name

MI

Signature Last Name

Suffix

Date

Company

Email Address

Phone Number

###-###-####

Contact Preference

If you have selected traditional mail as your preferred contact method. This may result in delay in receipt of any procedural or final order. If you accept these terms, please check below.

I accept

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