Fillable GRAMBLING STATE UNIVERSITY PARKING VIOLATION APPEAL FORM APPEALANT (Grambling State University)

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GRAMBLING STATE UNIVERSITY PARKING VIOLATION APPEAL FORM APPEALANT (Grambling State University)

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GRAMBLING STATE UNIVERSITY
PARKING VIOLATION APPEAL FORM
APPEALANT INFORMATION-PLEASE PRINT-This will be used to mail your decision. Please attach ticket
G No_____________________________________________ Today’s Date________________________________
Citation No_________________________________________ License Plate (_________)_____________________
Violation____________________________________________ Phone No (___________)_____________________
____________________________________________________ Permit#____________________________________
Name
_____________________________________________ _____I would like to appear before the
Street/P O Box Parking Appeals Committee
_____________________________________________
City State Zip
_____ Student _____ Faculty _____ Staff
____________________________________________________________________________________
THIS APPEAL CANNOT BE PROCESSED IF FORM IS INCOMPLETE
____________________________________________________________________________________
BASIS FOR APPEAL-In the space below, state with clarity all reasons and basis for appeal. Please print clearly
_____________________________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
I hereby certify that the above is a true and accurate statement of my appeal
Signature Date
FOR OFFICE USE ONLY-DO NOT WRITE BELOW THIS LINE
______Denied __________________________________________
______Granted __________________________________________
______Granted with the following conditions _________________________________________
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GRAMBLING STATE UNIVERSITY PARKING VIOLATION APPEAL FORM APPEALANT (Grambling State University)

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Completed 8 February 2021

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