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Request for Appeal of Change in Contract Status (Form 1):
Employee:
__________________________________
Print Name
__________________________________
Signature
__________________________________
Date
Please remember to attach a summary of the basis for your appeal.
Office of the Chancellor Date Received: ___________________________________________.
Receiving Employee in the Chancellor’s Office: __________________________________.
Printed Name
___________________________________.
Signature
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signature
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5
Appeal Receipt and Conference Notification (Form 2):
Receipt Notice Sent To:
__________________________________
Print Name
Receipt Notice Sent By:
__________________________________
Print Name
CMRRR No.: __________________________________
Certified Mail Return Receipt Request No.
Date Receipt of Notice Sent: __________________________________
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Appeal Receipt and Conference Notification
I acknowledge receipt of your Appeal challenging the recommendation my office has received
under Section IV.F.8 of the Lone Star College System District Policy Manual for a change in your
contract status. I have tentatively scheduled your conference for the date, time, and place below.
If this time conflicts with your schedule, or you are otherwise unable to make this appointment,
please let me know as soon as possible so we can reschedule to a more convenient time. I must
inform you of my decision within 15 working days of receiving your Notice of Appeal. In light of
that requirement, this conference must occur relatively soon to allow me sufficient time to consider
your Appeal in detail before that deadline.
Time: _______________________
Location: _______________________
Date: _______________________
____________________________ __________________
Dr. Stephen C. Head Date
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Request for Board Appeal of Change in Contract Status (Form 3):
Employee:
__________________________________
Print Name
__________________________________
Signature
Specific Board Policy Allegedly Violated: _____________________________
(Please reference specific policy sections) _____________________________
Please remember to attach a summary of the basis for your appeal.
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signature
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