Fines Appeal Form

Instructions

Please fill out the form below completely.
Required Items are marked with an asterisk.

*Enter Your Name *Telephone Number: *M#/Card# Date: *Email: *Address: Address2: *City: *State: *Zip: *Campus: *Select One:

*Items for which fines were assessed:

Time and Place of Return:

*Circumstances which lead you to believe that the fine should be waived or reduced.(Please be as specific as possible. Without accurate or sufficient information, the appeal cannot be processed. Please do not include protected medical information in your appeal.)