Document Number: UCL-17500-E
Description: This form is provided to parties to UI appeal hearings for their use per statutory requirement.
Comments: Information on how to complete the form and where to send it is included in the second page of the form.
Content Contact: UI BOLA
Document Attachment: UCL-17500-E (pdf/143 KB)
NOTE: When using Google Chrome, you may notice overlapping text when you select file, print. Deselect the 'fit to page' option and the text will no longer overlap.
Note: If you need this form in an alternate format, please send a message to the Content Contact listed above.