Hearing Rights Acknowledgement Form
Please review and acknowledge your hearing rights by completing this form. Your responses confirm your understanding of the rights listed below.
Full Name
*
First Name
Last Name
Date of Acknowledgement
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Email Address
example@example.com
Please acknowledge each of the following rights by checking the box next to each statement:
*
I understand I have the right to be informed of the hearing process.
I understand I have the right to be present at the hearing.
I understand I have the right to present evidence and witnesses.
I understand I have the right to be represented or seek assistance.
I understand I have the right to receive a written decision following the hearing.
If you have any comments or questions, please enter them below.
Signature
*
Submit Acknowledgement
Submit Acknowledgement
Should be Empty: