Student Traffic Appeals Form

Student Traffic Appeals Form
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Name: SSN: - -

Permit#: License Plate #: Citation #:

Citation Date: Today's Date:

Reason for Appeal: (Be brief; please print)
*Falsification, misrepresentation, and/or distortion of any information contained in this appeal is a violation of the student code of conduct.*

Hearing:
I wish to submit this form as a written appeal of my citation, and do not wish to personally appear.

I wish to personally appear on the next available hearing date. (Court Sessions are held in the University Center. The dates are posted in the Student Government Association Office, Room 411, University Center).

Signed: _____________________________________ Date _________________

For Office Use Only

Action Taken: Upheld Denied Reduced      Amount Reduced $ _________________

Final Cost: ______________________________

Location:   ______________________________

Reason for Decision:

Signature of Official: _________________________________________________

PS 9/95-459

The University of Memphis, One of the Tennessee Board of Regents institutions,
is an Equal opportunity/Affirmative Action University.