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Parking Appeal Form
Name:_______________________________ Date of Birth: _____________________(mm/dd/yyyy)
The decision regarding your appeal will be communicated to you by email. Please print your
email clearly below.
Email : _____________________________________________________________
Ticket #:
Please attach a copy of the ticket to this form. You must use additionalforms ifyou are
appealing more than one ticket.
In the space provided, please indicate the reason for your appeal. Be as descriptive as possible
when explaining the appeal. (If needed, attach additional sheets.) Mail or return the completed
form to the Campus Police Department at the address listed above within seven (7) days of
issuance date or your right to appeal will be forfeited. Please refer to the Assumption College
Parking and Traffic Regulations to answer any questions .
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Signature:__________________________________
FOR OFFICE USE ONLY - TO BE COMPLETED BY CAMPUS POLICE
Date:______________
DECISION OF APPEALS BOARD IS FINAL
Appeal Filed:
Date: ____/____/____ Time: __________ AM/PM
Appeal Accepted By: _____________________________________________ Hearing Date: ____/____/____
____________ AM/PM
PAF 02-21-03 Revised 11-18-19
Appeal is:
____ GRANTED ____ DENIED
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