Form Cdcr 602 - Inmate/parolee Appeal - California printable pdf download

STATE OF CALIFORNIA

DEPARTMENT OF CORRECTIONS AND REHABILITATION

INMATE/PAROLEE APPEAL

CDCR 602 (REV. 08/09)

Side 1

IAB USE ONLY

Institution/Parole Region:

Log #:

Category:

____________________

_____________________

_________

FOR STAFF USE ONLY

You may appeal any California Department of Corrections and Rehabilitation (CDCR) decision, action, condition, policy or regulation that has a material

adverse effect upon your welfare and for which there is no other prescribed method of departmental review/remedy available. See California Code of

Regulations, Title 15, Section (CCR) 3084.1. You must send this appeal and any supporting documents to the Appeals Coordinator (AC) within 30 calendar

days of the event that lead to the filing of this appeal. If additional space is needed, only one CDCR Form 602-A will be accepted. Refer to CCR 3084 for

further guidance with the appeal process. No reprisals will be taken for using the appeal process.

Appeal is subject to rejection if one row of text per line is exceeded.

WRITE, PRINT, or TYPE CLEARLY in black or blue ink.

Name (Last, First):

CDC Number:

Unit/Cell Number:

Assignment:

State briefly the subject of your appeal (Example: damaged TV, job removal, etc.):

A. Explain your issue (If you need more space, use Section A of the CDCR 602-A):_________________________

________________________________________________________________________________________________

B. Action requested (If you need more space, use Section B of the CDCR 602-A): __________________________

________________________________________________________________________________________________

Supporting Documents: Refer to CCR 3084.3.

Yes, I have attached supporting documents.

List supporting documents attached (e.g., CDC 1083, Inmate Property Inventory; CDC 128-G, Classification Chrono):

_____________________________________________

No, I have not attached any supporting documents. Reason :____________________________________________

________________________________________________________________________________________________

Inmate/Parolee Signature: _______________________________________ Date Submitted: ____________________

By placing my initials in this box, I waive my right to receive an interview.

C. First Level - Staff Use Only

Staff – Check One: Is CDCR 602-A Attached?

Yes

This appeal has been:

Bypassed at the First Level of Review. Go to Section E.

Rejected (See attached letter for instruction) Date: ________________ Date: _______________ Date: ________________ Date: ________________

Cancelled (See attached letter) Date: ________________

Accepted at the First Level of Review.

Assigned to: ________________________________________ Title: ________________ Date Assigned: _____________ Date Due:________________

First Level Responder: Complete a First Level response. Include Interviewer’s name, title, interview date, location, and complete the section below.

Date of Interview: ___________________________ Interview Location: ______________________________________________

Your appeal issue is:

Granted

Granted in Part

Denied

Other: __________________________________________________

See attached letter. If dissatisfied with First Level response, complete Section D.

Interviewer: ____________________________ Title: ___________ Signature: _________________________________ Date completed:_____________

(Print Name)

Reviewer: _____________________________ Title: ___________ Signature: _________________________________

(Print Name)

Date received by AC:______________

AC Use Only

Date mailed/delivered to appellant ____ / ____ / ____

Form Cdcr 602 - Inmate/parolee Appeal - California

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