Fill - Free fillable Blue Ridge Community College - BRCC Parking Citation Appeal Form PDF form

Updated: May 2, 2018 C:\Users\broneic\Desktop\to do\4-30-18\accessible\Parking Citation Appeal Form.docx

BRCC Parking Citation Appeal Form

Vehicle Owner: Please complete this form, attach the citation in question and forward to the Public Safety

Office (Houff Student Center) within 10 calendar days of the violation.

 If the appeals committee votes in your favor, the citation will be voided.

 If the appeal is denied, you have thirty (30) calendar days from the date on the original citation to

pay the fine or an additional $10 late fee will be applied.

 Payment is to be made at the cashier’s window in the Houff Student Center during regular business

hours (M-F, 8:30AM-5:00PM).

Please check the box that applies, and complete all requested information: PRINT CLEARLY

 Student  Staff  Faculty

Name: _____________________________________________ Empl ID# ________________________

Address:____________________________________ ______________________ _______ _________

(street) (city) (state) (zip)

Telephone No: ________________________Email for Notification: ___________________________________________

You will be notified of the appeals committee’s decision via email.

Citation No: __________________Parking Permit No: ____________________License Plate No: __________________

You may use the lines below to explain clearly and concisely the basis for your appeal (why you think you should not

have been given or should not have to pay the citation). Please attach any corroborating evidence or statements (i.e.

doctor’s statements, repair bills, receipts or any pertinent information in addition to your statement). This form will

be sent to the appeals committee by email.

__________________________________________________________________________________________________

___________________________________________ _________________________

Signature Date

Email completed form to: idcard@brcc.edu

Fill Online, Printable, Fillable, Blank Blue Ridge Community College - BRCC Parking Citation Appeal Form Form