One form must be completed for each citation in question. No appeal will be accepted 120 hours after the citation has been written (Saturdays, Sundays, and holidays excluded). Citation Number * Citation Date * MC Parking Decal Number * Classification Freshman Sophomore Junior Senior Other Student ID (not require for faculty/staff) * First Name * Middle Name Last Name * Email * Campus Address (if applicable) Box Number Dorm West Tower East Tower Mary Nelson Latimer-Webb Whittington Quick Hitt-McCullough Cockroft-Caldwell Ratliff Hederman Gunter Chrestman Fairmount University Place Phone Number Home Address City State Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas U.S. Minor Outlying Islands Utah Vermont Virgin Islands Virginia Washington Washington, D.C. West Virginia Wisconsin Wyoming Zip Home Phone Appeal Use this space to state your appeal and any information pertaining to your case that may aid the Judicial Council in making its decision. * All decisions will be finalized within two weeks. I affirm that the information given in this application is accurate and complete to the best of my knowledge. Additionally, I understand that entering untrue statements will lead to further judicial action. By checking this box, I agree to the above statements * I agree In lieu of a signature, please check if you agree to the statement above and state your full name. Signature *
