Instructions: Complete all sections of this form. Your signature is required.
This form will be provided to the Campus Safety & Security Supervisor for review and decision within 5 working days
from the date the appeal was received. You will be notified of the decision via U.S. Mail by copy of this appeal along
with 2
level appeal rights.
Please check one:
NAME _____________________________________________ TODAY’S DATE ___________________________
ADDRESS__________________________________________ CITATION NO. & DATE_____________________
CITY/STATE/ZIP ____________________________________ PHONE: __________________________________
LICENSE PLATE NO. ________________________________ PARKING PERMIT NO. ____________________
(All appeals will be considered under the regulations listed in Chapter 132S-300 WAC and College policy. Please be a
specific as possible, you may attach pictures or additional documents substantiating this appeal).
I affirm that this statement is true and accurate to the best of my recollection. I also understand if I pursue a 2
appeal, the decision of the Citation Review Committee is final and binding without further right of review.
Action Taken
Parking Citation Appeal
Campus Safety &
Supervisor and/or the Citation Review Committee (“CRC” or the “Committee”) will make a
citation appeal based on your written statement. Please complete and submit the form within (5) five
business days from the date the citation was issued. You may print and mail the form to Columbia Basin College, Attn:
Campus Security, 2600 N. 20th Ave., V Bldg., MS-V1, Pasco, WA 99301; print and drop off the form at the Security Office
during business hours.
Level Appeal
Decision-Campus Safety
& Security Supervisor
his is to inform you that your appeal contesting the above referenced citation has been:
Denied (Failure to file within 5 days)
Appeal Granted ____________________
Fine Imposed $_______
Fine Reduced $________ Waived/Dismissed Warning
Campus Safety & Secu
rity Supervisor:
_________________________________ Date: __________________
Security Office Use Only
Received: _________________
If you are dissatisfied with the 1
level of appeal above, you may request a review with the Citation Review
Committee within five (5) days of receipt of the Campus Safety & Security Supervisor’s decision. Submit this
completed form, including action taken by the first appeal decision.
Level Appeal
You may appear at the hearing to present your statement in person or to add additional information to your written
statement for the committee to consider. If you would like to attend, please check the box below. Once your appeal is
scheduled, you will be notified via U. S. Mail. The decision by the Committee for the second-level appeal is binding
and final and you will be notified by U.S. mail as soon as practicable.
Request an appearance before the Committee
Decision-Citation Review Committee
This is to inform you that your second level appeal contesting the above referenced citation has been:
Denied (Failure to file within 5 days)
Appeal Granted ____________________ Fine Imposed $_______
Fine Reduced $________ Waived/Dismissed Warning
Conditional Findings/Comments: __________________________________________________________________
Citation Review Committee: _______________________________________ Date: __________________
Columbia Basin College complies with the spirit and letter of state and federal laws, regulations and executive orders pertaining to civil rights, Title IX, equal opportunity and affirmative action. CBC
does not discriminate on the basis of race, color, creed, religion, national or ethnic origin, parental status or families with children, marital status, sex (gender), sexual orientation, gender identity or
expression, age, genetic information, honorably discharged veteran or military status, or the presence of any sensory, mental, or physical disability, or the use of a trained dog guide or service animal
(allowed by law) by a person with a disability, or any other prohibited basis in its educational programs or employment. Questions or complaints may be referred to the Vice President for Human
Resources & Legal Affairs and CBC’s Title IX/EEO Coordinator at (509) 542-5548. Individuals with disabilities are encouraged to participate in all college sponsored events and programs. If you have
a disability, and require an accommodation, please contact the CBC Resource Center at (509) 542-4412 or the Washington Relay Service at 711 or 1-800-833-6384. This notice is available in
alternative media by request.