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Old 01-27-2011, 12:14 AM
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Default Copy Of Form 602

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.
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 ____ / ____ / ____
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.
S T A F F U S E O N L Y
C. First Level - Staff Use Only Staff – Check One: Is CDCR 602-A Attached? Yes No
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:________________
STATE OF CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATION
INMATE/PAROLEE APPEAL
CDCR 602 (REV. 08/09) Side 2
D. If you are dissatisfied with the First Level response, explain the reason below, attach supporting documents and submit to the Appeals Coordinator
for processing within 30 calendar days of receipt of response. If you need more space, use Section D of the CDCR 602-A.
__________________________________________________ __________________________________________________ ________________________
__________________________________________________ __________________________________________________ ________________________
__________________________________________________ __________________________________________________ ________________________
__________________________________________________ __________________________________________________ ________________________
__________________________________________________ __________________________________________________ ________________________
__________________________________________________ __________________________________________________ ________________________
Inmate/Parolee Signature: __________________________________________________ _______ Date Submitted :____________________________
E. Second Level - Staff Use Only Staff – Check One: Is CDCR 602-A Attached? Yes No
This appeal has been:
By-passed at Second Level of Review. Go to Section G.
Rejected (See attached letter for instruction) Date: ________________ Date: ________________ Date: ________________ Date: _______________
Cancelled (See attached letter)
Accepted at the Second Level of Review
Assigned to: ______________________________ Title: ______________ Date Assigned: _________________ Date Due: ________________________
Second Level Responder: Complete a Second Level response. If an interview at the Second Level is necessary, include interviewer’s name and title,
interview date and 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 Second Level response, complete Section F below.
Interviewer: ____________________________ Title: _______________ Signature: ______________________________ Date completed :___________
(Print Name)
Reviewer: _____________________________ Title: _______________ Signature: ______________________________
(Print Name)
Date received by AC: ____________________
AC Use Only
Date mailed/delivered to appellant ____ /____ /____
F. If you are dissatisfied with the Second Level response, explain reason below; attach supporting documents and submit by mail for Third Level
Review. It must be received within 30 calendar days of receipt of prior response. Mail to: Chief, Inmate Appeals Branch, Department of Corrections and
Rehabilitation, P.O. Box 942883, Sacramento, CA 94283-0001. If you need more space, use Section F of the CDCR 602-A.
__________________________________________________ __________________________________________________ ________________________
__________________________________________________ __________________________________________________ ________________________
__________________________________________________ __________________________________________________ ________________________
__________________________________________________ __________________________________________________ ________________________
__________________________________________________ __________________________________________________ ________________________
Inmate/Parolee Signature: __________________________________________________ __________ Date Submitted: _______________________
G. Third Level - Staff Use Only
This appeal has been:
Rejected (See attached letter for instruction) Date: ___________ Date: ___________ Date: ___________ Date: __________ Date: ___________
Cancelled (See attached letter) Date: _________________
Accepted at the Third Level of Review. Your appeal issue is Granted Granted in Part Denied Other: ________________________
See attached Third Level response.
T Third Level Use Only
Date mailed/delivered to appellant ____ /____ /____
Request to Withdraw Appeal: I request that this appeal be withdrawn from further review because; State reason. (If withdrawal is conditional, list
conditions.)
__________________________________________________ __________________________________________________ ________________________
__________________________________________________ __________________________________________________ ________________________
__________________________________________________ __________________________________________________ ________________________
__________________________________________________ __________________________________________________ ________________________
________________________________________ Inmate/Parolee Signature: ___________________________________________ Date:______________
Print Staff Name: __________________________Title: ________________ Signature:___________________________________ Date:______________




This is the new 602 form.
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  #2  
Old 01-27-2011, 12:17 AM
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KLINUS KLINUS is offline
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Join Date: Jan 2006
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Default

STATE OF CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATION
INMATE/PAROLEE APPEAL FORM ATTACHMENT
CDCR 602-A (08/09) Side 1
IAB USE ONLY Institution/Parole Region: Log #: Category:
____________________ _____________________ _________
FOR STAFF USE ONLY
Attach this form to the CDCR 602, only if more space is needed. Only one CDCR 602-A may be used.
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:
A. Continuation of CDCR 602, Section A only (Explain your issue) :______________________________________
__________________________________________________ ______________________________________________
__________________________________________________ ______________________________________________
__________________________________________________ ______________________________________________
__________________________________________________ ______________________________________________
__________________________________________________ ______________________________________________
__________________________________________________ ______________________________________________
__________________________________________________ ______________________________________________
__________________________________________________ ______________________________________________
__________________________________________________ ______________________________________________
__________________________________________________ ______________________________________________
__________________________________________________ ______________________________________________
__________________________________________________ ______________________________________________
__________________________________________________ ______________________________________________
__________________________________________________ ______________________________________________
__________________________________________________ ______________________________________________
__________________________________________________ ______________________________________________
__________________________________________________ ______________________________________________
__________________________________________________ ______________________________________________
Inmate/Parolee Signature: ____________________________________________ Date Submitted:
________________
S T A F F U S E O N L Y
B. Continuation of CDCR 602, Section B only (Action requested): __________________________________________________ ________________
__________________________________________________ __________________________________________________ ______________________
__________________________________________________ __________________________________________________ ______________________
__________________________________________________ __________________________________________________ ______________________
__________________________________________________ __________________________________________________ ______________________
__________________________________________________ __________________________________________________ ______________________
__________________________________________________ __________________________________________________ ______________________
__________________________________________________ __________________________________________________ ______________________
__________________________________________________ __________________________________________________ ______________________
__________________________________________________ __________________________________________________ ______________________
__________________________________________________ __________________________________________________ ______________________
__________________________________________________ __________________________________________________ ______________________
Inmate/Parolee Signature: __________________________________________________ _______ Date Submitted: ___________________________
STATE OF CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATION
INMATE/PAROLEE APPEAL FORM ATTACHMENT
CDCR 602-A (08/09) Side 2
D. Continuation of CDCR 602, Section D only (Dissatisfied with First Level response): ________________________________________________
__________________________________________________ __________________________________________________ ______________________
__________________________________________________ __________________________________________________ ______________________
__________________________________________________ __________________________________________________ ______________________
__________________________________________________ __________________________________________________ ______________________
__________________________________________________ __________________________________________________ ______________________
__________________________________________________ __________________________________________________ ______________________
__________________________________________________ __________________________________________________ ______________________
__________________________________________________ __________________________________________________ ______________________
__________________________________________________ __________________________________________________ ______________________
__________________________________________________ __________________________________________________ ______________________
__________________________________________________ __________________________________________________ ______________________
__________________________________________________ __________________________________________________ ______________________
__________________________________________________ __________________________________________________ ______________________
__________________________________________________ __________________________________________________ ______________________
__________________________________________________ __________________________________________________ ______________________
__________________________________________________ __________________________________________________ ______________________
__________________________________________________ __________________________________________________ ______________________
__________________________________________________ __________________________________________________ ______________________
__________________________________________________ __________________________________________________ ______________________
__________________________________________________ __________________________________________________ ______________________
Inmate/Parolee Signature: __________________________________________________ _______ Date Submitted: ___________________________
F. Continuation of CDCR 602, Section F only (Dissatisfied with Second Level response): ______________________________________________
__________________________________________________ __________________________________________________ ______________________
__________________________________________________ __________________________________________________ ______________________
__________________________________________________ __________________________________________________ ______________________
__________________________________________________ __________________________________________________ ______________________
__________________________________________________ __________________________________________________ ______________________
__________________________________________________ __________________________________________________ ______________________
__________________________________________________ __________________________________________________ ______________________
__________________________________________________ __________________________________________________ ______________________
__________________________________________________ __________________________________________________ ______________________
__________________________________________________ __________________________________________________ ______________________
__________________________________________________ __________________________________________________ ______________________
__________________________________________________ __________________________________________________ ______________________
__________________________________________________ __________________________________________________ ______________________
__________________________________________________ __________________________________________________ ______________________
__________________________________________________ __________________________________________________ ______________________
__________________________________________________ __________________________________________________ ______________________
Inmate/Parolee Signature: __________________________________________________ ________ Date Submitted: __________________________
__________________
  #3  
Old 01-27-2011, 12:19 AM
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KLINUS KLINUS is offline
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Join Date: Jan 2006
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Default

STATE OF CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATION
INMATE/PAROLEE GROUP APPEAL Page No. _____ of _____
CDCR 602-G (08/09)
IAB USE ONLY Institution/Parole Region: Log #: Category:
____________________ _______________________ _________
FOR STAFF USE ONLY
This is a group appeal signature attachment sheet. Attach it to your group CDCR 602. You are to legibly print your name, number,
assignment and housing, then sign and date the form. By signing, you are agreeing to the issue and action requested; and you
acknowledge that this appeal counts towards the allowable number of appeals in the period in which it is filed.
PRIMARY APPELLANT WRITE, PRINT, or TYPE CLEARLY in black or blue ink.
A. Summarize the specific issue that you are appealing as identified in the attached CDCR 602:______________________
__________________________________________________ __________________________________________________ ____
__________________________________________________ __________________________________________________ ____
__________________________________________________ __________________________________________________ ____
B. Summarize the action requested: __________________________________________________ ______________________
__________________________________________________ __________________________________________________ ____
__________________________________________________ __________________________________________________ ____
__________________________________________________ __________________________________________________ ____
NOTE: I, the undersigned, agree that the facts presented in this appeal are true. I agree with the issue presented
and I am requesting the action indicated. In the event the Primary Appellant transfers or elects to withdraw from the
appeal, I understand that I may become the primary appellant for purposes of processing the group appeal.
CDC Number Name Assignment Unit/Cell # Signature Date
CDC Number Name Assignment Unit/Cell # Signature Date
CDC Number Name Assignment Unit/Cell # Signature Date
CDC Number Name Assignment Unit/Cell # Signature Date
CDC Number Name Assignment Unit/Cell # Signature Date
CDC Number Name Assignment Unit/Cell # Signature Date
CDC Number Name Assignment Unit/Cell # Signature Date
CDC Number Name Assignment Unit/Cell # Signature Date
CDC Number Name Assignment Unit/Cell # Signature Date
CDC Number Name Assignment Unit/Cell # Signature Date
CDC Number Name Assignment Unit/Cell # Signature Date
CDC Number Name Assignment Unit/Cell # Signature Date
S T A F F U S E O N L Y
Name (Last, First): CDC Number: Assignment: Unit/Cell # Signature Date
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