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A+ Citizenship and Attendance Appeal Form

Appeal Form

Appeal Scheduled:__________________________

A+ Citizenship or Attendance Appeal Form

 

Student Name:____________________________________________Date:_________________

 

Parent Name:__________________________________________________________________

 

Parent Address:________________________________________________________________

 

City:________________________________State:___________  Zip Code:__________________

 

Parent Signature____________________________________Telephone___________________

 

Student Signature___________________________________Telephone___________________

 

 

       
   

 
 

This request is to appeal a(n):                                    Citizenship Decision               Attendance Issue

 

       
   

 
 

Semester:                    Fall                  Spring              Academic Year:___________________

 

In the space below, please indicate the absence(s) and the reason for the request to be reviewed.  If additional space is needed, please attach another sheet of paper.

 

Date of Absence         Reason for Absence

 

______________        ____________________________________________________________

______________        ____________________________________________________________

_____________          ____________________________________________________________

 

 

In the space below, please indicate the citizenship issue and the reason for the request to be reviewed.  If additional space is needed, please attach another sheet of paper:

 

Date of Occurrence:_____________________________

 

Details:

 

 

 

 

 

 
 

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