Student Judicial System Appeal Form
Name: _______________________________________________
Local Address: _________________________________________
Telephone #(s):__________________ SSN: __________________
State the reason(s) for your appeal (please be specific and concise) ________________________________________________________________________
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Signature of person submitting the appeal: ____________________________________
Date: ____________________________
Appeal received by: _____________________________________________________
Date Appeal received: _______________
Please return to: Student Judicial Programs, PSU #405, and address any questions to 836-6937.