Print Name and Address Below
Montana Tech
Parking Violation Appeal
Name: Student ID#:
Add
ress:
Ci
ty: State: Zip:
Pho
ne Number:
IMPORTANT: MUST BE WITHIN 30 DAYS AND FILLED OUT COMPLETELY OR APPEAL WILL NOT BE ACCEPTED
Write (legibly) your reason(s) for the appeal in the space below. Please be specific and concise about the
circumstances. This appeal must be in written form and submitted within thirty (30) calendar days of the
violation. Your appeal will be reviewed Parking Appeals Committee and their decision will be final. Non-
payment of fines is submit to collection methods used by Montana Tech. Please email the completed form to
BusinessServices@mtech.edu or submit to Business Services in the SSC.
Citation/Ticket Number(s):
Ticket issued date(s):
License Plate: State: Registered Owner:
Reason for Appeal:
*continue on back if needed
I certify that all information listed herein is true and correct. If all information is not complete or beyond 30
days of violation, the appeal will not be accepted and the fine will be upheld.
Signature: Date:
____APPROVED
____REDUCED FINE
____UPHELD FINE $_______
____REDUCE TO WARNING
DATE RECEIVED_______
APPEALS BOARD DATE______
