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Appeals Form

Section 1

FIELDS IN RED ARE REQUIRED FIELDS

Status Student Faculty Staff Visitor Other

Name (Last, First, M.I.):
Student ID# or SSN:
E-Mail Address:
Address:
City:
State:
Zip Code:
Phone Number:
Section 2

Do you wish to appeal:
Individual Citation (Section 3 must be filled out)
All Citations or other charges (Go to Section 4)

License Plate#: State:

Are you a current permit holder? Yes No
 If Yes, Current Permit Number

Section 3

Citation #1

Citation Number: Violation:
Date of Citation: Location:

Section 4

Statement
I affirm that the following is true to the best of my knowledge

Entering your name and date below acts as your signature and authorizes Washington University Parking Services to forward your appeal to the Parking Appeals Committee on your behalf. ALL DECISIONS ARE FINAL.

Name
Date