Request for an Internal Review

                             Date:____________________

Ontario Works - London

151 Dundas St.,

P.O. Box 5045

LONDON, ON

N6A 4L6

 

 

                                RE: _________________________      Case Number: ____________________________

                                       (NAME)                                                                                                         (OR Date of Birth)

 

 

                                 Dear Supervisor:

 

                                On _______________, I received the Notice of Decision dated __________________

                                   (date I got the decision)                                         (Date of  Notice of Decision letter)

 

 

                                I am requesting an internal review of this decision.    My reasons for asking for an internal review are:

 

__________________________________________________________________________
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__________________________________________________________________________
__________________________________________________________________________

 

 

                                Sincerely Yours,

 

                                _____________________________________

                                (Signature)

 

                                ___________________________________________________

 

                                ___________________________________________________

                                (Address)